Complications after endovascular repair of type B aortic dissection.
OBJECTIVE
To outline the complications encountered after endoluminal treatment in patients with type B aortic dissection.


METHODS
Between 1999 and 2001, 14 patients (12 men; mean age 60.3 years, range 39-79) with isolated type B aortic dissection (13 chronic, 1 acute) underwent aortic stent-grafting. Three patients with chronic dissection presented an acute clinical picture and were managed emergently. The left subclavian artery was intentionally covered by the prosthesis in 9 patients. Follow-up studies were performed at 6-month intervals.


RESULTS
Stent-graft implantation was technically successful in all patients, but incomplete sealing (endoleak) of the entry site required additional proximal stent-graft implantation in 4. The left subclavian artery remained patent in 5 patients. Secondary conversion was required in 3 patients: 2 for acute type A dissection resulting from injury to the aortic arch by Talent endografts and a sustained hemorrhage (left hemothorax). In another patient, a secondary intramural hematoma subsided spontaneously. Anterior spinal artery syndrome in 1 patient persisted at 1 month. No bypass was necessary for the 9 patients with the covered left subclavian arteries. Mean follow-up was 14 months (range 1-23).


CONCLUSIONS
Stent-grafting is feasible in patients with type B aortic dissection, although it is associated with a considerable rate of complications. Frank reporting of these sequelae for a variety of stent-grafts is of paramount importance to clarifying the limitations of the method.
Pamler
Reinhard S
RS
Department of Thoracic and Vascular Surgery, University of Ulm, Germany. reinhard.palmer@medizin.uni-ulm.de
Kotsis
Thomas
T
Görich
Johannes
J
Kapfer
Xaver
X
Orend
Karl-Heinz
KH
Sunder-Plassmann
Ludger
L
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D012086:Reoperation; D015607:Stents; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation