Stent-graft Repair Of Aortic Dissections Research Articles

Mortality within the endovascular treatment in Stanford type B aortic dissections

Endovascular stent-graft repair of aortic dissections is a relatively new procedure, and although apparently less invasive, the efficacy and safety of this technique have not been fully established. To evaluate mortality in patients with complicated Stanford type B aortic dissections submitted to endovascular treatment. Clinical, anatomical, imaging and autopsy data of 23 patients with complicated type B aortic dissections were reviewed from November 2004 to October 2007. The main indications for transluminal thoracic stent-grafting included: persistent pain in spite of medical therapy, signs of distal limb ischemia, signs of aortic rupture, progression of aneurismal dilation of the descending aorta during follow-up (defined as a diameter > 50 mm) and the diameter of descending thoracic aorta of 40 mm or larger at the onset of aortic dissection. Data were analyzed statistically; all p-values were two-tailed and differences < 0.05 were considered to indicate statistical significance. Continuous variables were expressed as mean (± SD), and medians were compared by the Student's t test. Differences in categorical variables between the groups were analyzed by the Chi-square or Fisher's exact test. The procedure presented primary technical success in 82.6% of patients. Four patients (17.4%) had an incomplete proximal entry seal. Three patients (13%) died within 30 days of the procedure and eight patients (34.8%) died after 30 days. Endovascular correction of complicated Stanford type B aortic dissections is a feasible and effective treatment option.

Factors Portending Endoleak Formation After Thoracic Aortic Stent-Graft Repair of Complicated Aortic Dissection

Background— Endoleaks after stent-graft repair of aortic dissections are poorly understood but seem substantially different from those seen after aneurysm repair. We studied anatomic and clinical factors associated with endoleaks in patients who underwent stent-graft repair of complicated type B aortic dissections. Methods and Results— From 2000 to 2007, 37 patients underwent stent-graft repair of acute (≤14 days; n=23), subacute (15 to 90 days; n=10) or chronic (&gt;90 days; n=4) complicated type B aortic dissections using the Gore Thoracic Excluder (n=17) or TAG stent-grafts (n=20) under an investigator-sponsored protocol. Endoleaks were classified as imperfect proximal seal, flow through fenestrations or branches, or complex (both). Variables studied included coverage of the left subclavian artery, aortic curvature, completeness of proximal apposition, dissection chronicity, and device used. Endoleaks were found during follow-up (mean, 22 months) in 59% of patients, and they were associated with coverage of the left subclavian artery (complex, P &lt;0.001), small radius of curvature (type 1 and complex, P =0.05), and greatest length of unapposed proximal stent graft (complex, P &lt;0.0001). During follow-up, 10 endoleaks resolved spontaneously, 6 required reintervention for false lumen dilatation, and 2 were stable without clinical consequences. Conclusions— Endoleaks are common after stent-graft repair of aortic dissection and may lead to false lumen enlargement necessitating reintervention. Anatomic complexities such as acute aortic curvature and covered side branches were associated with endoleaks, illustrating the need for dissection-specific device development.

Transluminal placement of endovascular stent-grafts for the treatment of type A aortic dissection with an entry tear in the descending thoracic aorta

Purpose: The current therapy for type A aortic dissection is ascending aortic replacement. Operative mortality and morbidity rates have been markedly improved because of recent advances in surgical techniques and anesthesiology. However, type A aortic dissection with an entry tear in the descending thoracic aorta is still a surgical challenge because of the need for extensive aortic replacement. Methods: Ten patients with type A aortic dissection were treated with endovascular stent-grafts. The false lumen of the ascending aorta was patent in five patients, and it was thrombosed in the other five patients. The entry tears were located in the descending thoracic aorta in all cases. Seven patients had acute dissection, and three patients had subacute dissection. Four patients had pericardial effusion. Stent-grafts were fabricated from expanded polytetrafluoroethylene and Z-stents. Results: Entry closure was achieved in all patients. Complete thrombosis of the false lumen of the ascending aorta was observed after stent-grafting in all patients. A second stent-graft was required in two patients to obtain complete thrombosis of the false lumen of the descending thoracic aorta. No procedure-related complications were observed, with the exception of a minor stroke in one patient. During a mean follow-up period of 20 months, no aortic rupture or aneurysm formation was noted in either the ascending or descending thoracic aorta, and all patients were alive and doing well. The abdominal aortic aneurysm enlarged after stent-grafting in one patient, and this was treated by closing the fenestrations of the abdominal aorta with stent-grafts. Conclusion: Stent-graft repair of aortic dissection with an entry tear in the descending thoracic aorta is a safe and effective method and may be an alternative to surgical graft replacement in highly selected patients. (J Vasc Surg 2001;34:1023-8.)

Ultrafast computed tomography for minimally invasive coronary artery bypass grafting

J Thorac Cardiovasc Surg 1998;116:173-4