Elective Stent-Graft Treatment of Aortic Dissections
To retrospectively review 8 years' experience with stent-graft treatment of aortic dissections at a single institution.
Forty-six patients (31 men; mean age 59 years, range 38-88) underwent stent-graft treatment for 9 Stanford type A and 37 type B aortic dissections (9 acute phase, 13 subacute, 24 chronic). Custom-designed self-expanding stainless steel Z stents covered with polytetrafluoroethylene were used (n=20) until low-profile modular stent-grafts became available for percutaneous delivery (n=26).
Endovascular stent-graft deployment was technically successful in 44 (96%) patients; the 2 failed cases owing to intraprocedural migration and graft torsion were converted to surgery. There were 5 type I endoleaks for a clinical success (entry tear exclusion) of 85% (39/46). Complications included 3 cases of transient renal failure, 2 puncture site pseudoaneurysms, 1 guidewire-induced new intimal tear (converted), and 2 cases of stent-induced saccular aneurysms (1 converted). Follow-up at a mean 34 months (range 12-96) showed complete resolution of the thoracic false lumen in 14 (74%) of 19 acute/subacute patients treated successfully; 3 (16%) showed a reduced thoracic false lumen diameter. In the 23 chronic-phase patients treated successfully, 8 (35%) had complete resolution of the thoracic false lumen, and 11 (48%) showed size reduction. Enlargement of the abdominal aortic false lumen due to persistent flow into re-entry tear(s) occurred in 3 (13%).
Stent-graft treatment is a feasible and effective treatment modality in aortic dissection. However, close follow-up is mandatory to monitor new intimal tear, saccular aneurysms, or enlargement of the abdominal aortic false lumen.
Available from: Luiz Marcelo Malbouisson
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ABSTRACT: Objective: Questions regarding the specific patient/ disease that should be submitted to the endovascular procedur e still r emain unclear . The purpose of this study is to evaluate the endovascular treatment in chronic type B aortic dissections. Methods: Between 2003 and 2006, 1 1 patients with chr onic type B aortic dissection were submitted to endovascular pr ocedur e thr ough femoral ar ter y . All of them wer e monitored with CT within 6 months, at 1 year and afterwards annually . W e pr ospectively evaluated false lumen patency and thoracic and abdominal aortic diameters in each time point. The data comparisons wer e made using Anova and chi-square tests with SPSS 13. Results: The endovascular stent-graft deployment was technically successful for all patients, with no hospital mor tality . During the follow-up period, the false lumen flows remained persistent in the thorax in 27.3% of the patients and in the abdomen in 81,8%. However , in all patients, in both segments, the aorta diameter was not significantly changed in size and shape. Conclusion: Despite the small number of studied
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ABSTRACT: Endovascular treatment is becoming the most important treatment modality in the complex management of type B dissection, providing benefits to both acute and chronic patients. Growing technical experience and improving stent-graft devices have resulted in better patient outcome and expanded clinical indications. Nevertheless, similar to any treatment option, this less invasive method has its inherent risks. Several cases of iatrogenic dissection have been reported in the literature, underlying the need for guidelines to minimize this risk and improve procedural safety. Extension of the dissection after endovascular repair of type B dissection does not appear to be device-specific, but related primarily to aortic wall alterations or adverse anatomy that arise most frequently in hypertensive patients or those with challenging aortic configuration. An accurate examination of the aortic wall and dissection anatomy and careful intraprocedural device manipulation and balloon molding may help avoid this potentially life-threatening complication.
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