[To resolve the difficulties of entering into the aortic dissections' true lumen in endovascular graft exclusion].
OBJECTIVE
To review the methods about resolving the difficulties of entering into the aortic dissections' true lumen in endovascular graft exclusion.


METHODS
The patients who had Stanford B type thoracic aortic dissection and been treated with endovascular graft exclusion from September 1998 to February 2004 were reviewed. The operations performed under DSA surveillance. In the operation, the wire was difficult to enter into the true lumen of the aortic dissection in 28 cases, and was wrong into the false lumen then into the true lumen in 4 cases. Five methods were used to resolve these problems, including catheter smoking technique, different position projection, left brachial artery puncture proximal guide-wire floating technique, arterial choice of entering into the true lumen and guide-wire transfixion between proximal and distal.


RESULTS
The method of catheter smoking technique was used in 32 cases, different position projection in 12 cases, left brachial artery puncture proximal guide-wire floating technique in 10 cases, arterial choice of entering into the true lumen in 28 cases, and guide-wire transfixion between proximal and distal in 2 cases. The wires were ultimately successful to enter the true lumen and the stent-grafts excluded successfully the tears of the aortic dissections in 32 cases.


CONCLUSIONS
The difficulty of entering into the true lumen and the wrong way into the false lumen could lead to losing the operation, even a disaster. The problem could be resolved by some methods of endovascular techniques.
Lu
Qing-sheng
QS
Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Institute of Vascular Surgery of People's Liberation Army, Shanghai 200433, China. luqs@xueguan.net
Jing
Zai-ping
ZP
Bao
Jun-min
JM
Zhao
Zhi-qing
ZQ
Feng
Xiang
X
Zhao
Jun
J
D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D015901:Angiography, Digital Subtraction; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies