True-lumen collapse in aortic dissection: part II. Evaluation of treatment methods in phantoms with pulsatile flow.
OBJECTIVE
To discover and evaluate the effective treatment methods to prevent or relieve true-lumen collapse in models of aortic dissection.


METHODS
Two phantoms were built to simulate type B aortic dissection. After true-lumen collapse was induced, experiments were conducted to evaluate the effectiveness of clinically relevant variables in relieving the collapse. Variables included entry-tear size, branch-vessel flow distribution, distal reentry communication between the true and false limbs, aortic fenestrations, and pump output. To test the effect of closing the entry tear, a stent-graft was deployed over the entry tear under physiologic conditions in a mock-flow loop. The difference in the effect of each variable on the prevention and relief of true-lumen collapse was also investigated.


RESULTS
It was more difficult to relieve true-lumen collapse than it was to prevent it. Placement of a stent-graft over the entry tear was the most effective method of relieving true-lumen collapse. Less-effective procedures included opening a false-lumen outflow branch and opening the distal reentry branch. Opening the fenestration-branch loops, meant to simulate the creation of artificial fenestrations in the intimal flap, did not relieve true-lumen collapse.


CONCLUSIONS
The definitive treatment for true-lumen collapse in aortic dissection is direct repair of the entry tear to decrease false-lumen inflow. Otherwise, increasing the false-lumen outflow and/or creating distal fenestrations between the true and false lumina distal to the level of the compromised aortic branch are less-effective alternatives.
Chung
J W
JW
Division of Cardiovascular-Interventional Radiology, Stanford University Medical Center, Stanford Vascular Center, CA 94304-5105, USA.
Elkins
C
C
Sakai
T
T
Kato
N
N
Vestring
T
T
Semba
C P
CP
Slonim
S M
SM
Dake
M D
MD
D000784:Aortic Dissection / Q000503:physiopathology / Q000628:therapy*; D001014:Aortic Aneurysm / Q000503:physiopathology / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008955:Models, Cardiovascular; D019047:Phantoms, Imaging; D011673:Pulsatile Flow / Q000502:physiology*; D015607:Stents; D016896:Treatment Outcome