Midterm results of stent-graft repair of acute and chronic aortic dissection with descending tear: the complication-specific approach.
BACKGROUND
Endovascular stent-graft placement for the treatment of patients with aortic dissection is emerging as an attractive alternative to conventional cardiac operations. However, there has been no report of longer-term follow-up. The purpose of this study is to describe our midterm results with endovascular stent-graft repair for the treatment of patients with aortic dissections.


METHODS
Thirty-eight patients with aortic dissections with descending tears were treated with endovascular stent-grafting. Ten patients had acute type A, 14 patients had acute type B, and 14 patients had chronic type B dissection. Stent grafts fabricated from expanded polytetrafluoroethylene-covered Z stents were placed to close entry tears in all patients through the delivery systems introduced from the femoral or the iliac arteries.


RESULTS
Two patients with complicated acute type B dissection, who would have required surgical intervention, died within 30 days of the procedure, although no other patients died within the same period. There were no late deaths during the mean follow-up period of 27 months. Early and late complication rates were 33% and 36%, respectively, in patients with acute dissection, whereas rates were 4% and 0% (P <.05 vs patients with acute dissection) in patients with chronic dissection.


CONCLUSIONS
Entry closure with endovascular stent-graft placement may be a safe and effective method for the treatment of patients with aortic dissection. It could be an alternative to conventional surgical intervention in selected patients with chronic dissection. However, strict patient selection and close follow-up seem mandatory in patients with acute dissection receiving Z stent-based stent-grafts. Stent-graft repair should be delayed for acute type B dissection without complications.
Kato
Noriyuki
N
Department of Radiology Mie University Hospital, 2-1784 Edobashi, Tsu, Mie 514, Japan. kato@mri.gw.medic.mie-u.ac.jp
Shimono
Takatsugu
T
Hirano
Tadanori
T
Suzuki
Tomoaki
T
Ishida
Masaki
M
Sakuma
Hajime
H
Yada
Isao
I
Takeda
Kan
K
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000628:therapy*; D017545:Aortic Aneurysm, Thoracic / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome