RF88 TRANSFEMORAL BARE-METAL STENT FOR TREATMENT OF RESIDUAL AORTIC ARCH DISSECTION AFTER SURGICAL REPAIR OF ACUTE TYPE A AORTIC DISSECTION.

Abstract

Background and aim: Here we evaluate the usefulness of transfemoral uncovered stent implantation to avoid secondary conventional surgery for residual type A aortic dissection of aortic arch after ascending aorta replacement. Methods: From June 2009 to April 2015, 11 patients were treated with transfemoral implantation of uncovered stents in the aortic arch after surgical replacement of ascending aorta performed on average 4.7 ± 2.3 years earlier.. An enlarged dissected aortic arch or a dangerous median growth of more than 5 mm/yr or impending rupture presenting as chest pain were indications for treatment. The dissected aortic tracts diameter must not exceed 45 mm. 5 patients (45.5%) were treated with Djumbodies Dissection System, 6 patients (54.5%) with Jotec E-XL aortic stent. Results: There were no perioperative deaths or permanent neurologic complications. Primary procedural success was obtained in all patients and the residual type A aortic dissection in aortic arch was obliterated, with disappearance of the false lumen. Median ICU stay was 24 hours, post-operative hospital stay was 5.2 ± 1.4 days. One death, not aortic related, occurred during follow-up period (mean 5.2 ± 1.9 years). Descending thoracic aorta diameter significantly increased in 3 patients (27.3%): one patient (9.0%) needed a secondary conventional surgery, the other 2 (18.2%) of a distal extension with PETTICOAT approach. Conclusions: Endovascular approach with uncovered metal bare stent is surely an evolving strategy to perform a purely endovascular treatment, indicated only for treatment of aortic arch with a diameter of less than 40 or 45 mm, to avoid progressive thoracic aortic dilatation and/or rupture.