Aortic dissection and its endovascular management.
Aortic dissection is the commonest life-threatening event involving the aorta, affecting 5-10 per million people per year. Without treatment, half of patients with acute proximal aortic dissections die within 24 hours, and 60% of patients with acute distal aortic dissections die within 1 month. Only 10% of patients with proximal dissections and 40% of those with distal dissections will be alive at 1 year. Patients with chronic distal dissections are at risk of aortic rupture with nearly 20% requiring intervention. The aim of management of aortic dissection is to reduce propagation of the dissection plane and prevent the fatal complications of this condition. A paradigm shift in the surgical management of these patients began in the late 1990s with the reporting of two small series of patients being treated with custom-designed covered stents delivered through a unilateral arteriotomy. Both studies demonstrated the feasibility and technical success in endovascular sealing of the proximal intimal entry tear in patients with type B thoracic dissections.
Hinchliffe
R J
RJ
St George's Regional Vascular Institute, London, UK. rhinchli@sgul.ac.uk
Halawa
M
M
Holt
P J
PJ
Morgan
R
R
Loftus
I
I
Thompson
M M
MM
D000784:Aortic Dissection / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D002908:Chronic Disease; D018450:Disease Progression; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D015607:Stents; D016896:Treatment Outcome