Endovascular Treatment of Acute Complicated Aortic Dissection: Long-term Follow-up of Clinical Outcomes and CT Findings

Abstract

To investigate changes of the aorta and affected end organs after endovascular treatment of an acute complicated aortic dissection. Twenty patients who underwent endovascular treatment for acute complicated aortic dissection were evaluated for computed tomographic (CT) findings of the aorta and affected end organs. Three patients had Stanford type A dissection and 17 patients had Stanford type B dissection. The follow-up period ranged from 3 to 2,719 days (mean, 731 d). The outer diameter of the aorta and the inner diameter of the true and false lumen were compared between initial and follow-up CT. Renal perfusion, size, and changes of other affected organs were evaluated on initial and follow-up CT studies. Branch vessel malperfusion improved in 18 of 20 patients (90%). The outer diameter of the aorta was increased at all levels (thoracic aorta, 10.9%; abdominal aorta, 11.8%; infrarenal aorta, 12.6%). The greatest expansion of aortic false lumen was seen in the thoracic aorta (19%). Annual growth rates were 3.64 mm per year in the thoracic aorta, 2.64 mm per year at the celiac level of the abdominal aorta, and 1.42 mm per year in the infrarenal aorta. Affected kidneys showed atrophy in 67% of cases in the right kidney and 83% of cases in the left kidney. Limb malperfusion improved in 78% of patients, but gallbladder ischemia improved in only 33%. Although fenestration and endovascular stent placement is effective for improving acute malperfusion syndrome in type B aortic dissection, it cannot prevent delayed expansion of the aorta.