Endovascular treatment of type B thoracic aortic dissections.
OBJECTIVE
To evaluate the initial experience of endovascular repair of aortic dissections from a single center.


METHODS
From June 1999 to March 2002, endovascular stent grafting was performed in 20 high-risk patients (16 to 80 years). Eighteen patients had a type B dissection (14 acute and 4 chronic). Two patients had chronic type A dissection. Preoperative work-up included CT and MRI to evaluate the extent of the dissection, the relation to the left subclavian artery, the size of false and true lumen, and branch complications.


RESULTS
Stent-graft deployment was technically successful in all cases. None was converted to open repair. Three patients died within 30 days, i.e., a 15% mortality rate. Four patients (20%) had a perioperative stroke. Paraplegia was observed in one case. No migration of the stent grafts or endoleaks was observed during the mean follow-up period of 13 months. In all but two patient thrombosis of the false lumen was noted.


CONCLUSIONS
Endovascular treatment of thoracic dissections is feasible. Early results are encouraging. While endovascular repair with stent-grafts is progressing rapidly as a viable strategy for aortic dissections in selected patients careful investigations must continue to focus on its safety. Randomized controlled trials are urgently needed.
Lonn
Lars
L
Department of Interventional Radiology, Sahlgrenska University Hospital, SE 413 45, Göteborg, Sweden. lars.lonn@vgregion.se
Delle
Martin
M
Falkenberg
Marten
M
Lepore
Vincenzo
V
Klingenstierna
Hans
H
Radberg
Göran
G
Risberg
Bo
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents