title: Emergency stent-graft placement in thoracic aortic dissection and evolving rupture.
abstract: BACKGROUND
  Even with rapid diagnosis and effective medical treatment mortality in type B aortic dissection with evidence of extraaortic leakage of blood remains high. Considering a mortality rate of 29% to 50% associated with emergency surgical repair, the concept of endovascular stent-graft placement may become a life-saving option in impending or evolving rupture by endovascular sealing of the entry tear and subsequent abortion of leakage.
  
  
  METHODS
  The concept was tested by comparing short-term and 1-year outcomes of 11 patients after emergency endovascular stent-graft placement with historic-matched control patients subjected to conventional therapy. All patients had acute type B dissection complicated by loss of blood into periaortic spaces.
  
  
  RESULTS
  Emergency stent-graft placement was successful without periprocedural morbidity, aborted leakage, and ensured reconstruction of the dissected aorta; at a mean follow-up of 15 +/- 6 months no death had occurred in the stent-graft group whereas four patients had died with conventional treatment (p < 0.05).
  
  
  CONCLUSIONS
  With appropriate logistics and expertise, type B aortic dissection with leakage and evolving rupture may benefit from nonsurgical reconstruction of the dissected segment by endovascular stent grafts.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, University Hospital Rostock, Ernst-Heydemann-Strasse 6, 18055 Rostock, Germany. christoph.nienaber@med.uni-rostock.de
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Ince
authors.forename: Frank
authors.initials: F
authors.lastname: Weber
authors.forename: Tim
authors.initials: T
authors.lastname: Rehders
authors.forename: Michael
authors.initials: M
authors.lastname: Petzsch
authors.forename: Thomas
authors.initials: T
authors.lastname: Meinertz
authors.forename: Dietmar H
authors.initials: DH
authors.lastname: Koschyk
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents