Endovascular stent-graft placement for complications of acute type B aortic dissection.
OBJECTIVE
To review the concepts and current clinical results of endovascular stent-graft placement for acute complicated type B aortic dissection.


RESULTS
The optimal treatment for patients with dissections confined to the descending aorta (Stanford type B-AD) remains a matter of debate. Usually, antihypertensive medical therapy with strict blood pressure lowering below 135/80 mm Hg represents the first choice for patients with uncomplicated type B-AD. Patients with acute complicated type B-AD remain a major therapeutic challenge because surgery of the descending aorta is still associated with high morbidity and mortality. In 1999, endovascular stent-graft placement was introduced as a novel, less invasive treatment option for patients with type B aortic dissection. Current indications include acute (contained) aortic rupture, symptomatic ischemic branch vessel involvement, early aortic expansion, or unrelenting pain. So far, few studies on stent-graft placement in patients with acute complicated aortic dissection have been published reporting an early mortality between 0 and approximately 20%.


CONCLUSIONS
To date, there is limited experience with endovascular stent-graft placement for acute complicated type B aortic dissection demonstrating its feasibility and life-saving potential. The endovascular approach can avoid the major trauma of open surgery and should help to get patients out of the acute life-threatening phase of the disease; however, long-term results are needed to assess the durability of this treatment.
Eggebrecht
Holger
H
Department of Cardiology, West-German Heart Center Essen, University of Duisburg-Essen, Essen, Germany. holger.eggebrecht@uni-essen.de
Lönn
Lars
L
Herold
Ulf
U
Breuckmann
Frank
F
Leyh
Rainer
R
Jakob
Heinz G
HG
Erbel
Raimund
R
D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D000792:Angiography; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D006801:Humans; D008875:Middle Aged; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome