Treatment of Thoracic Aortic Dissection with Stent-Grafts: Midterm Results

Division of Cardiology, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Journal of Endovascular Therapy (Impact Factor: 3.35). 01/2003; 9(6):817-21. DOI: 10.1583/1545-1550(2002)009<0817:TOTADW>2.0.CO;2
Source: PubMed


To evaluate the early and midterm outcomes after stent-graft implantation for dissection in the descending thoracic aorta.
Sixteen custom-made endovascular stent-grafts were implanted in 15 patients (10 men; mean age 55.9 +/- 13.7 years, range 32-82) with descending thoracic aortic dissection. Indications for stent-graft implantation were persistent symptoms unresponsive to medical treatment or progressive enlargement of the false lumen. Clinical and imaging surveillance with computed tomography was performed within 1 month of the procedure and at 3 to 6-month intervals in follow-up.
Endovascular stent-graft implantation at the target site was successful in 14 (93%) patients; 1 device migrated, leaving the false lumen open to flow in the failed case. One (7%) patient who was treated emergently for rupture died suddenly 2 days after the procedure. Over an average follow-up of 31.5 +/- 23.8 months, 1 (7%) patient died and 2 (14%) patients underwent surgical treatment due to recurrent dissection. The remaining 10 patients showed complete thrombosis of the false lumen; in 3, the false lumen completely resolved.
Endovascular stent-graft implantation in descending thoracic aortic dissection is a feasible, safe, and effective treatment modality. However, further studies are necessary in a greater number of patients to determine if wider application of this minimally invasive procedure is justified.

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    • "The introduction of endovascular repair which was described as a less invasive method of treating descending thoracic aortic disease was a significant advance in the care of these high risk patients. Shim et al. (12) reported the feasibility and safety of stent-grafting type B dissections with a 93% technical success rate (13). White et al. recently reported acceptable 30-day and 1 year mortality and morbidity rates after emergency TEVAR for complicated type B aortic dissections (i.e. "
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    • ". Its application has also been extended to various thoracic aortic pathologies including aneurysm [7], trauma [8] and dissection [9]. Its use in mycotic aneurysms is controversial because of the concern of stent-graft infection. "
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