Early and medium-term results of stent-graft treatment of DeBakey type III aortic dissection.
OBJECTIVE
The safety and effectiveness of transcatheter stent-graft treatment in the early and medium-term postoperative period was assessed in patients with DeBakey type III aortic dissection.


METHODS
Transcatheter stent-graft implantation was performed in 37 patients who had aortic dissection with entry sites in the descending thoracic aorta. Entry sites were closed with a stent-graft consisting of a Gianturco Z stent covered with an UBE woven Dacron graft.


RESULTS
There were no in-hospital deaths or serious complications after operation. In 5 patients, a new intimal tear developed at the distal end of the stent-graft 8 to 13 months after operation. It was closed by additional stent-graft placement in 2 patients. The rate of thrombosis of the false lumen of the descending thoracic aorta 5 to 10 days, 3 to 6 months, and 12 months after operation was 70%, 80%, and 81%, respectively. As compared with before operation, the short axis of the true lumen increased (1.4+/-0.8 cm before operation, 2.1+/-0.5 cm at 5-10 days, and 2.7+/-0.6 cm at 3-6 months) and that of the false lumen decreased (2.9+/-0.9 cm, 2.3+/-0.9 cm, 1.5+/-1.2 cm), indicating enlargement of the true lumen and shrinkage of the false lumen. The false lumen was completely obliterated within 3-6 months after operation in 6 patients.


CONCLUSIONS
Our early postoperative results show that transcatheter stent-graft implantation is a safe and effective procedure for the management of DeBakey Type III aortic dissection. Devices with a minimal risk of causing intimal tears should be developed.
Kiyotaka
I
I
Department of Cardiovascular Surgery, Yokohama City University, Medical Center, Yokohama, Japan. imoto@urahp.yokohama-cu.sc.jp
Shinichi
S
S
Keiji
U
U
D000784:Aortic Dissection / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002406:Catheterization, Peripheral / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome