The endovascular repair of aortic dissection: early clinical results of 178 cases
ABSTRACT To discuss the safety, feasibility, efficacy and problems of endovascular repair for aortic dissection.
From June, 1998 to Dec, 2004, 178 aortic dissections were treated by stent-grafts, including 76 acute cases and 102 chronic cases, 19 cases with Stanford A and 159 cases with Stanford B. Under local or general anesthesia, every stent-graft was deployed at the proper position of first tear entry through femoral artery under X-ray fluoroscopic. The changes of hemodynamic in true and false lumen, visceral and limbs blood supply were investigated after operation.
10 cases combined with left common carotid artery or left subclavian artery or hepatic artery and superior mesenteric artery bypass. 36 left subclavian arteries were covered simultaneously without bypass and the average blood pressure of left brachial artery was (61.6 +/- 23.7) mm Hg. The stent-grafts were deployed above thoracic 8 in 159 cases and below thoracic 8 in 19 cases. This group included 3.4% 30-day death rate, 12.9% endoleak rate after deployment, and without misplace of stent grafts, migration, rupture, conversion to open surgery and paraplegia complication. The average operation time 1.5 h (0.5-4.3 h), blood loss 140 ml (30-500 ml), movement recover time 1.8 d (0.5-21.0 d), food recover time 1.5 d (0.5-9.0 d). The true lumen blood supply in most of damaged visceral arteries were improved. Follow up between 1 month to 76 months, the endoleak rate was 6.4% one month later.
The endovascular repair is a safe, efficacy and feasible method to aortic dissection. The long term results keep in follow up.
- Asian cardiovascular & thoracic annals 09/2007; 15(4):275-7. DOI:10.1177/021849230701500401
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ABSTRACT: Type B dissection has traditionally been managed medically if uncomplicated and surgically if associated with complications. This practice has resulted in most centers reporting significant morbidity and mortality if open repair is required. In the setting of malperfusion, operative repair has been conjoined with fenestration or visceral stenting to improve outcomes. Endovascular stent grafts seem to offer an attractive alternative in the acute complicated type B dissection, with reduced mortality and morbidity, particularly paralysis, compared with open repair. It is reasonable to consider endovascular stent grafts as another tool in managing dissection, but to recognize that open surgical repair still plays an important role, and that the data that define indications and outcomes are still emerging.Surgical Clinics of North America 11/2007; 87(5):1047-86, viii-ix. DOI:10.1016/j.suc.2007.08.003 · 1.93 Impact Factor
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ABSTRACT: Endovascular repair by stent graft has been developed as a safe and less-invasive treatment for descending thoracic and abdominal aortic diseases. In case of involvement of the aortic arch, the challenge in endovascular repair is to maintain blood flow to the brain and upper extremities. Several studies have been done trying to repair this difficult part of the aorta with different stent grafts, and we have developed a new stent-graft device for aortic arch reconstitution. We implanted the new device in canine models to test its feasibility. The new stent graft was composed of three components: parts I and II were both bifurcated, one with long, narrow limb and the other short and wide, and part III was a tubular component. Ten adult hybrid dogs were operated with the new stent-graft procedure, and eight were successfully implanted with the stent grafts. The technical success rate was 80% (8 of 10). Five dogs survived for 3 months without obvious cerebral, visceral or limb ischaemia. Autopsies showed that the implanted stent grafts were patent and the vital side branches of aortic arch were well preserved. Our study demonstrates that it is possible to reconstruct aortic arch with the new branched stent grafts. The advantage of this device is that it is modular, more adaptable and surgical bypass could be possibly avoided.European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 04/2009; 37(5):560-5. DOI:10.1016/j.ejvs.2009.01.017 · 3.07 Impact Factor