Endovascular treatment of descending aortic dissection (type B): short- and medium-term results.
BACKGROUND
Optimal treatment of type B dissections is open to debate. The use of endoprostheses is an option that requires evaluation.


OBJECTIVE
To report our experience with endoprostheses in type B aortic dissections.


METHODS
We report our short- and medium-term results with covered prostheses for the treatment of acute (n=7) and chronic (n=28) type B aortic dissections. The criteria used to indicate treatment were the same as those usually used for surgery: acute complications or dilated aneurysm. Cover of the main intimal tear was obtained in all cases with an improvement in symptoms in patients with acute dissections.


RESULTS
Early mortality was 14.3% (five patients), linked in three cases to the occurrence of a retrograde dissection of the ascending aorta. No neurological complications were observed. Four patients required an additional endovascular and/or surgical procedure. On early control scans, complete thrombosis of the false lumen at the thoracic level was observed in 40% of cases, partial thrombosis in 42.8% and an absence of thrombosis in 11.4%. After a mean follow-up of 20.8 months, one patient died of a pneumopathy. No secondary aneurysm expansion was noted at the thoracic stage whereas three patients presented with dilation of the abdominal aorta.


CONCLUSIONS
The results of treatment of type B dissections with covered endoprostheses are encouraging. However, the morbimortality associated with treatment and the uncertainty of long-term results do not allow the use of this therapeutic option outside the criteria usually recognized to indicate surgery.
Flecher
E
E
Université Pierre-et-Marie-Curie Paris VI, AP-HP, Service de chirurgie cardiovasculaire et thoracique (Pr I. Gandjbakhch), Groupe hospitalier Pitié-Salpêtrière, Paris.
Cluzel
P
P
Bonnet
N
N
Aubert
S
S
Gaubert
A
A
Pavie
A
A
Jault
F
F
Leprince
P
P
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017130:Angioplasty; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies