Revolutionary treatment of aneurysms and dissections of descending aorta: the endovascular approach.
BACKGROUND
Acute aortic dissection is a life-threatening medical condition. It is associated with high morbidity and mortality. Type B dissections are usually managed clinically during the acute phase. Conventional surgery carries high mortality rates due to the presence of serious complications. We herein present treatment of this condition with a less invasive endovascular approach. Other clinical situations such as penetrating ulcers, intramural hematomas, and true aneurysms of descending aorta were similarly treated.


METHODS
From December 1996 to March 2002, 191 patients with type B dissections were treated with self-expandable, polyester-covered stents. There were 120 patients (62.8%) with type B dissections, 61 patients (31.9%) with true aneurysms, 6 patients (3.1%) with penetrating ulcers or intramural hematomas, and 4 patients (2.1%) with trauma. Patients with abdominal aneurysms (44) and stents introduced under direct vision through the aortic arch (70) were excluded. The stent graft was delivered in the catheterization laboratory under general anesthesia, with induced hypotension and heparinization. All stents used were made in Brazil (Braile Biomedics, Sao Jose do Rio Preto, SP).


RESULTS
The procedure was performed in 191 consecutive cases. The success rate was 91.1% (174/191). Success was defined as occlusion of the thoracic intimal tear, or exclusion of the aneurysm without leaks. Hospital mortality was 10.4% (20/191 patients), due to preoperative comorbidities. Six patients required conversion to surgery. No case of paraplegia was observed. An actuarial survival curve showed 87.4% +/- 29% survival in the late follow-up period.


CONCLUSIONS
Stent grafts are an important development in the treatment of descending aortic aneurysms or dissections. This novel approach may replace conventional surgical treatment of these conditions, with earlier intervention and less morbidity.
Buffolo
Enio
E
Federal University of São Paulo, Paulista School of Medicine and Affiliated Hospitals, SP, Brazil. enio.buffolo@terra.com.br
da Fonseca
José Honório Palma
JH
de Souza
José Augusto Marcondes
JA
Alves
Claudia Maria Rodrigues
CM
D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D000800:Angioplasty, Balloon; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005500:Follow-Up Studies; D006801:Humans; D011183:Postoperative Complications / Q000401:mortality; D011474:Prosthesis Design; D015607:Stents; D015996:Survival Rate