[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.
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ABSTRACT: Thoracic endografts (stent grafts) have emerged as a less invasive modality to treat various thoracic aortic lesions. The intentional coverage of the left subclavian artery (LSA) during the placement of these endografts is associated with several complications including stroke, spinal cord ischemia, and arm ischemia. In this review, we synthesize the available evidence regarding the complications associated with LSA coverage. We searched electronic databases (MEDLINE and EMBASE) from January 1990 through February 2008 for studies that included patients who received thoracic endografts and had intentional LSA coverage. Eligible studies had a control group that either received the endograft without LSA coverage or had primary revascularization prior to coverage. Two independent reviewers determined trial eligibility and extracted descriptive, methodological and outcome data from each eligible study. Meta-analyses estimated Peto odds ratio (OR) and 95% confidence intervals (CI) to describe the strength of association between coverage and complications; the I(2) statistic described the proportion of inconsistency of treatment effect among studies not due to chance. We found 51 eligible observational studies. LSA coverage was associated with significant increase in the risk of arm ischemia (OR 47.7; CI, 9.9-229.3; I(2) = 72%, 19 studies) and vertebrobasilar ischemia (OR 10.8; CI, 3.17-36.7; I(2) = 0%; eight studies); and nonsignificant increase in the risk of spinal cord ischemia (OR 2.69; CI, 0.75-9.68; I(2) = 40%; eight studies) and anterior circulation stroke (OR 2.58; CI, 0.82-8.09; I(2) = 64%, 13 studies). There were no significant associations between LSA coverage and death, myocardial infarction, or transient ischemic attacks. The incidence of phrenic nerve injury as a complication of primary revascularization was 4.40% (CI, 1.60%-12.20%). Data on perioperative infection were sparse and rarely reported. Very low quality evidence suggests that LSA coverage increases the risk of arm ischemia, vertebrobasilar ischemia, and possibly spinal cord ischemia and anterior circulation stroke.Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 11/2009; 50(5):1159-69. · 3.52 Impact Factor
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ABSTRACT: We summarized all published studies for endovascular stent graft placement among patients with type B aortic dissection in China with respect to clinical success, complications, and outcomes. A meta-analysis was performed on all published studies of retrograde endovascular stent graft placement encompassing 3 or more patients with type B aortic dissection. Thirty-nine studies, involving a total of 1304 patients from January 2001 to December 2007, were included. The average patient age was 52 years. Procedural success was reported in 99.2% +/- 0.1% of patients. Major complications were reported in 3.4% +/- 0.1% patients, with the most severe neurologic complications in 0.6%. Periprocedural stroke was encountered more frequently than paraplegia (0.2% vs 0%). The overall 30-day mortality was 2.6% +/- 0.1%. In addition, 1.5% +/- 0.1% of patients died over a mean follow-up period of 27.1 +/- 17.5 months. Life-table analysis yielded overall survival rates of 96.9% at 30 days, 96.7% at 6 months, 96.4% at 1 year, 95.6% at 2 years, and 95.2% at 5 years. Although therapy with traditional medicines still remains the first line of treatment for type B aortic dissection, endovascular stent graft placement has shown its advantages, with a success rate of 99% or greater in a select cohort. The technical survival rate, major complications, and acute and midterm survival rates in the Chinese-language literature appeared to favorably compare with that seen in published literature. This analysis is the first to provide an overview of the currently available literature on endovascular stent graft placement in type B aortic dissection in China.The Journal of thoracic and cardiovascular surgery 05/2009; 138(4):865-72. · 3.41 Impact Factor