Treatment of thoracic aortic dissection with stent-grafts: midterm results.
OBJECTIVE
To evaluate the early and midterm outcomes after stent-graft implantation for dissection in the descending thoracic aorta.


METHODS
Sixteen custom-made endovascular stent-grafts were implanted in 15 patients (10 men; mean age 55.9 +/- 13.7 years, range 32-82) with descending thoracic aortic dissection. Indications for stent-graft implantation were persistent symptoms unresponsive to medical treatment or progressive enlargement of the false lumen. Clinical and imaging surveillance with computed tomography was performed within 1 month of the procedure and at 3 to 6-month intervals in follow-up.


RESULTS
Endovascular stent-graft implantation at the target site was successful in 14 (93%) patients; 1 device migrated, leaving the false lumen open to flow in the failed case. One (7%) patient who was treated emergently for rupture died suddenly 2 days after the procedure. Over an average follow-up of 31.5 +/- 23.8 months, 1 (7%) patient died and 2 (14%) patients underwent surgical treatment due to recurrent dissection. The remaining 10 patients showed complete thrombosis of the false lumen; in 3, the false lumen completely resolved.


CONCLUSIONS
Endovascular stent-graft implantation in descending thoracic aortic dissection is a feasible, safe, and effective treatment modality. However, further studies are necessary in a greater number of patients to determine if wider application of this minimally invasive procedure is justified.
Shim
Won-Heum
WH
Division of Cardiology, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea. whshim@yumc.yonsei.ac.kr
Koo
Bon-Kwon
BK
Yoon
Young-sup
YS
Choi
Donghoon
D
Jang
Yangsoo
Y
Lee
Do-Yun
DY
Chang
Byoung-chul
BC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D017541:Aneurysm, False / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D012086:Reoperation; D015607:Stents; D016019:Survival Analysis; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome