Emergent endovascular stent grafting for perforated acute type B dissections and ruptured thoracic aortic aneurysms.
BACKGROUND
The purpose of our study was to demonstrate the effectiveness of endovascular stent grafts in the treatment of acutely ruptured thoracic aortic aneurysms and type B dissections as an alternative to the conventional surgical approach in an emergency setting.


METHODS
From January 2001 to October 2001, we deployed 11 emergent endovascular stent grafts into the thoracic aorta. We treated seven ruptured aortic aneurysms and four acutely perforated type B dissections. Aortic rupture was confirmed preoperatively by spiral computed tomography. In all cases, hemothorax was present. The average interval from onset of symptoms to treatment was 28.5 hours. We used nine Talent and two Excluder stent grafts.


RESULTS
Deployment of the stent grafts was successful in nine cases. There were two cases of access failure due to small caliber of iliac arteries, and 1 of these patients died shortly after the procedure was abandoned, At 12 months of follow-up, there were no cases of paraplegia, stent migration, or endoleaks. There was, however, one temporary renal failure, and 2 patients required mechanical ventilation for more than 48 hours.


CONCLUSIONS
Our experiences with emergency endovascular stent grafting show that the procedure is technically feasible, with less morbidity and mortality than conventional open surgery, in high-risk patients.
Doss
Mirko
M
Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany. mirkodoss@aol.com
Balzer
Joern
J
Martens
Sven
S
Wood
Jeffrey P
JP
Wimmer-Greinecker
Gerhard
G
Moritz
Anton
A
Fieguth
Hans-Gerd
HG
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D000792:Angiography; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome