Emergency stent-graft placement in thoracic aortic dissection and evolving rupture.
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.
Nienaber
Christoph A
CA
Department of Internal Medicine, Division of Cardiology, University Hospital Rostock, Ernst-Heydemann-Strasse 6, 18055 Rostock, Germany. christoph.nienaber@med.uni-rostock.de
Ince
Hüseyin
H
Weber
Frank
F
Rehders
Tim
T
Petzsch
Michael
M
Meinertz
Thomas
T
Koschyk
Dietmar H
DH
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