Urgent thoracic aortal dissection and aneurysm: treatment with stent-graft implantation in an angiographic suite.
The aim of this study was to evaluate the feasibility of endoluminal stent-graft placement in an angiographic suite for the treatment of emergent type-B aortic dissections and ruptured thoracic aortal aneurysms. Twenty-six patients with either urgent type-B dissection (n=8) or aneurysms (n=18) of the descending thoracic aorta were chosen for stent-graft implantation. All patients received a multidetector-row CT angiography of the whole aorta and pelvic arteries prior to stent-graft implantation. All procedures were performed in a fully equipped digital subtraction angiography (DSA) suite under general anesthesia. In 20 patients Talent LPS tube grafts and in 4 patients an Excluder graft were used. Access was achieved via surgical cut-down in the left (n=7) or right (n=19) groin. Sealing was successful in 24 patients. The proximal covered portion of the stent graft was placed across the left subclavian artery in 2 patients. Procedural success was achieved in 23 of 24 patients. One patient required a second stent-graft placement before the aneurysm was sealed. One patient with an acute perforation of the descending aorta died due to cardiac failure prior to stent-graft implantation. In 1 patient stent-graft delivery failed due to severe calcification of both common iliac arteries. Endoluminal treatment of both urgent type-B aortic dissections and thoracic aortal aneurysms with stent graft is an attractive alternative treatment to surgical repair. The placement of stent grafts in an angiographic suite is a safe and feasible method with good clinical effectiveness and, so far, good clinical outcome.
Department of Diagnostic and Interventional Radiology, University Clinic Frankfurt/Main, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany. j.o.balzer@em.uni-frankfurt.de
Jörn O
JO
Balzer
Mirko
M
Doss
Axel
A
Thalhammer
Hans-Gerd
HG
Fieguth
Anton
A
Moritz
Thomas J
TJ
Vogl
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000628:therapy*; D000792:Angiography / Q000379:methods; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D015331:Cohort Studies; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D016896:Treatment Outcome