Endovascular treatment of complicated type-B aortic dissection with stent-grafts:: midterm results.
OBJECTIVE
To report the midterm results of the endovascular treatment of complicated type-B aortic dissection with use of stent-grafts.


METHODS
Ten patients with acute (n = 4) or chronic (n = 6) complicated type-B dissection were treated with custom-made stent-grafts. Indications for treatment included uncontrollable hypertension with dissection extension (n = 3), renal ischemia (n = 1), and false lumen aneurysm (n = 6). Stainless-steel Z-stents covered with polyester grafts were placed in the initial six patients. Nitinol stents covered with ultrathin polytetrafluoroethylene were used in the remaining four patients. The patients were followed-up with helical computed tomography for a maximum of 30 months (mean, 20 mo).


RESULTS
There was one technical failure related to the access site. Early complications included deep venous thrombosis (n = 1) and embolic stroke (n = 1). Complete thrombosis of the thoracic false lumen was achieved in six patients and partial thrombosis was achieved in three. Aneurysms developed at the ends of the stainless-steel stents in two patients, requiring additional stent-graft placement. Despite successful remodeling of the thoracic aorta, three of four patients with distal reentry into the abdominal aorta experienced progressive abdominal aortic aneurysm (AAA). AAA rupture developed in two patients; one rupture was fatal and the other was treated with emergency surgery.


CONCLUSIONS
Endovascular treatment of complicated type-B aortic dissection is technically feasible and effective. Closely monitoring the treated aorta is essential to detect early aneurysm formation at the ends of rigid stents. Despite adequate sealing of the tears in the thoracic aorta, dissection with distal reentry phenomenon into the abdominal aorta may evolve into AAA with late rupture.
Lopera
Jorge
J
Department of Radiology, Louisiana State University at New Orleans, 1542 Tulane Avenue, New Orleans, Louisiana 70112, USA.jloper@lsuhsc.edu
Patiño
Jario H
JH
Urbina
Carlos
C
García
Giovanni
G
Alvarez
Luis Guillermo
LG
Upegui
León
L
Jhanchai
Akkawat
A
Qian
Zhong
Z
Castañeda-Zuñiga
Wilfrido
W
D000497:Alloys; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D013193:Stainless Steel; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D000497:Alloys; D013193:Stainless Steel; C013616:nitinol; D011138:Polytetrafluoroethylene