title: Extension of dissection in stent-graft treatment of type B aortic dissection: lessons learned from endovascular experience.
abstract: Endovascular treatment is becoming the most important treatment modality in the complex management of type B dissection, providing benefits to both acute and chronic patients. Growing technical experience and improving stent-graft devices have resulted in better patient outcome and expanded clinical indications. Nevertheless, similar to any treatment option, this less invasive method has its inherent risks. Several cases of iatrogenic dissection have been reported in the literature, underlying the need for guidelines to minimize this risk and improve procedural safety. Extension of the dissection after endovascular repair of type B dissection does not appear to be device-specific, but related primarily to aortic wall alterations or adverse anatomy that arise most frequently in hypertensive patients or those with challenging aortic configuration. An accurate examination of the aortic wall and dissection anatomy and careful intraprocedural device manipulation and balloon molding may help avoid this potentially life-threatening complication.
authors.affiliation: Department of Radiology, University Hospital S. Orsola, Bologna, Italy. ross@med.unibo.it
authors.forename: Rossella
authors.initials: R
authors.lastname: Fattori
authors.forename: Luigi
authors.initials: L
authors.lastname: Lovato
authors.forename: Katia
authors.initials: K
authors.lastname: Buttazzi
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Gavelli
mesh_terms: D000784:Aortic Dissection / Q000601:surgery*; D017546:Angioscopy; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D002983:Clinical Competence; D006801:Humans; D015203:Reproducibility of Results; D015607:Stents