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


CONCLUSIONS
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.
Kato
N
N
Department of Radiology, and Thoracic and Cardiovascular Surgery, Mie University Hospital, Tsu, Japan. kato@mri-gw.medic.mie-u.ac.jp
Shimono
T
T
Hirano
T
T
Ishida
M
M
Yada
I
I
Takeda
K
K
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000145:classification / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D017544:Aortic Aneurysm, Abdominal / Q000145:classification / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000145:classification / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010490:Pericardial Effusion / Q000209:etiology; D011138:Polytetrafluoroethylene; D012086:Reoperation; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000209:etiology; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D011138:Polytetrafluoroethylene