Endograft Superior to Surgery in Thoracic Aneurysms

A recent midterm study has found the thoracic endograft TAG endoprosthesis (W.L. Gore and Associates), which was approved by the FDA early last year, to be superior to surgical repair for the treatment of thoracic aneurysms. The results were reported at the 60th Annual Meeting of the Society for Vascular Surgery.

According to lead investigator Michel Makaroun, MD, chief of vascular surgery, University of Pittsburgh School of Medicine, the minimally invasive endovascular procedures typically result in fewer early complications than standard open surgical interventions.

Some 140 patients were treated with the TAG device, and 94 patients underwent open surgery. Patients in the former group had a 60% lower total complication rate. The mortality rate in the endograft group was much lower than in the open surgery group (2% vs 12%), as was the incidence of paraplegia (3% vs 14%). In both groups, the stroke rate was 4%.

At 4 years, patients treated with the endograft continued to have lower total complication rates compared with open surgery. Only 4 patients in the endovascular group required reintervention, although 1 patient who developed an infection and required conversion to an open procedure died.

There were no aneurysm ruptures and no clinically significant migration or motion of the devices inside the aneurysm. Complications such as endoleaks diminished over the 4-year period to only about 5%. Between the first and 48th month after the device was implanted, sac sizes decreased in 46% of patients and increased in 24% of patients, Dr Makaroun noted.