A New Indication for Thoracic Stent Grafting
Michael Sywak, Maciej Dryjski, MD.
Buffalo, Buffalo, NY, USA.
OBJECTIVES: Our goal was to determine the experience on a national level the use for thoracic stent graft placement for prevention of aortic rupture in patients undergoing stereotactic body radiation therapy (SBRT) for periaortic tumors.
METHODS: Using Survey Monkey, and an 8 question survey was sent out to the program directors of all of the ACGME accredited vascular surgery fellowships as well as radiation oncology fellowships (n=131). There were a total of 35 (26.7%) respondents.
RESULTS: The majority of the respondents were vascular surgeons 88.5% in practice over 10 years. Interestingly, 68.6% have never been asked to place a thoracic sent graft for peri-aortic cancers being treated with SBRT. 35% Believe that there should be an indication for placing stent grafts to prevent aortic rupture for peri-aortic radiotherapy.
CONCLUSIONS: Placement of aortic stent grafts for off label use is controversial. Given the morbidity and mortality of aortic complications in patients treated with SBRT to the thoracic aorta we hoped to understand the nation experience with using thoracic stent graft placement as a prophylactic measure. It seems the nation experience reflects a rarity in placement of thoracic stent grafts as a protective measure against rupture. It makes sense that stenting would have a role for protection during periaortic SBRT, however there is no data to support its indication and the survey supports this finding. The majority of respondents do not think there should be an indication for placement of stent grafts as a prophylactic measure.
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