Combined surgical and endovascular treatment of aortic type A dissection.
OBJECTIVE
We describe a combined approach for treatment of a type A aortic dissection with surgical repair of the ascending aorta and transluminal stenting of the descending aorta, therefore minimizing the consequences on the untreated aortic arch and descending aorta.


METHODS
From December 2002 to June 2003, 5 consecutive patients (4 men, 1 woman) suffering from type A aortic dissection were treated with resection of the ascending aorta or aortic hemi-arch. Before the open distal aortic anastomosis the Endofit endovascular graft (Endomed Inc, Phoenix, AZ), was deployed under direct vision distally to the origin of the left subclavian artery.


RESULTS
Intraoperative stent graft placement was successful in all patients. There was no hospital mortality. Early results were satisfactory with a completely thrombosed false lumen in 2 patients and a partially thrombosed false lumen in 3 patients, 10 days after operation. Follow-up computed tomographic scan showed a completely thrombosed false lumen in 4 patients and a partially thrombosed false lumen in 1 patient.


CONCLUSIONS
This study shows that combined surgical and endovascular treatment of acute type A dissection is a feasible option, but further evaluation is necessary.
Panos
Aristotelis
A
Clinic for Cardiovascular Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland. aristotepanos@yahoo.com
Kalangos
Afksendiyos
A
Christofilopoulos
Panayiotis
P
Khatchatourian
Gregory
G
D000784:Aortic Dissection / Q000145:classification / Q000601:surgery*; D001014:Aortic Aneurysm / Q000145:classification / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D013927:Thrombosis / Q000209:etiology; D019737:Transplants; D016896:Treatment Outcome