Complicated Acute Type B Dissections—An 8-years Experience of Endovascular Stent-graft Repair in a Single Centre

Abstract

Objective To analyze the experience of a single centre using stent-grafts for treatment of complicated acute aortic type B-dissections (EVR-ABD). Design Retrospective analysis of prospectively collected data from patients undergoing EVR-ABD between January 1997 and December 2004. Methods EVR-ABD was performed in 31 patients (20 males, median age 74 years (IQR: 64–79)). Indications for treatment were aortic rupture (22 patients), intractable pain and hypertension (six patients), acute bowel ischemia (two patients) and transient paraplegia, lower limb and renal ischemia in one patient. Initially home-made devices (five patients) and subsequently commercially available thoracic stent-grafts were used. Results Five patients (16%) died within 30 days of EVR-ABD. Postoperative complications occurred in 15 (48%) patients, including one paraplegia converted to paraparesis after cerebrospinal fluid drainage, five strokes, three lower limb ischemia, three myocardial infarction, two pneumonia and one colitis). Re-interventions were required in nine patients (29%). Six more deaths occurred during a median follow-up of 22 (IQR: 16–34) months, two related to the stent-graft and four due to cardiac disease. Conclusions Stent-graft repair of complicated acute type B dissections seems to provide acceptable results and, therefore, it may be considered a valuable alternative to open surgery.