Minimally invasive therapy options in aortic dissections

Abstract

Current day therapy for aortic dissection is aimed at the relief of branch vessel ischemia and the prevention of aortic rupture or aneurysm formation. Malperfusion complicating aortic dissection has historically been treated by surgery. Operations in patients with branch-vessel involvement may be technically difficult and the operative mortality is reported to be between 25% and 51%. This may rise to above 70% in patients with critical mesenteric or renal ischemia. Over the past decade, successful relief of such ischemia using the interventional radiological techniques of balloon fenestration, stent implantation and/or thrombolysis has been reported. In addition to being less invasive, this approach is associated with a lower mortality, ranging between 0% and 25%. Patency of the false lumen increases the probability of aortic rupture or aneurysm formation. Recent studies have reported successful closure of the proximal entry site with the help of stent grafts. The aim of the intervention is to initiate a thrombosis of the false lumen and thus stabilize the dissection. Based on a review of the literature and our own experience, we discuss the percutaneous management of branch vessel ischemia complicating aortic dissection as well as the role of stent graft implantation in patients with aortic dissection.