Endovascular Surgery in Marfan Syndrome: CON

In this review, Kouchoukos presents an argument against the use of endovascular stenting for the management of thoracoabdominal disease in patients with Marfan syndrome, except in exceptional circumstances or when the endovascular stent is landed in previously-sited graft material.  The opinion is based upon the poor outcomes of a limited number of Marfan patients that are reported in the literature, including in-hospital mortality of 2.5% to 12.5% and primary treatment failure between 25.0% and 43.8%. This is compared with the excellent reported early outcomes of patients with Marfan syndrome undergoing open surgical repair of thoracoabdominal aortic disease, such as early mortality between 0% and 7%.