Résumé
Since the first endovascular treatment of an infrarenal abdominal aorta by Parodi et al. [1], endoluminal techniques have developed rapidly. In 1994, Dake et al. [2] showed the feasibility of treating descending thoracic aortic aneurysms by means of self-expandable covered endografts in 13 patients. Only 8 96 of their patients suffering from a thoracic aortic aneurysm were eligible for endovascular treatment. Ten years on, endovascular treatment of thoracic aneurysms has changed from homemade, experimental stent-grafts for anatomically favorable aneurysms to an established treatment using commercially manufactured devices in acute and chronic thoracic aortic diseases (such as aneurysms, dissections, traumatic ruptures, ulcerations and intramural hematomas) [3].
Initially, these techniques were mainly applied in patients with high surgical risks but indications for endovascular treatment progressively extended to patients eligible for conventional surgery.
The evident interest of these covered stents is to avoid a surgical procedure comprising: thoracotomy; double lumen tube intubation with a collapsed lung; extracorporeal circulation with systemic heparinization; and proximal clamping in patients with atherosclerotic comorbidities or associated lesions as a result of trauma.
The majority of recent studies shows reduced morbidity and mortality after endovascular treatment as compared to conventional surgery. However, specific complications of endovascular techniques have become apparent, including periprosthetic endoleaks, migration, kinking and prosthetic thrombosis.