[Endovascular treatment of type B aortic dissection].
BACKGROUND
Dissections that involve the ascending aorta are classified as type A, regardless of the site of the primary intimal tear, and all other dissections as type B. Type B dissections can have fatal ischemic and hemorrhagic complications. In the chronic state, dilatation and rupture can be mortal. Endovascular surgery is a therapeutic alternative, considering the high rate of complications of conventional surgery.


OBJECTIVE
To report the results of endovascular treatment of type B aortic dissection.


METHODS
Report of 36 treated patients (30 males) aged 43 to 87 years, with a type B aortic dissection. Seventy eight percent were hypertensive and 39% smoked. The diagnosis was confirmed by CAT scan. Acute patients were treated for complications and chronic patients, for dilatation. In the operating room, an endoprothesis was placed through the femoral artery, to cover the tear. The tear was located and the lumens were differentiated using angiography and transesophageal echocardiography.


RESULTS
All procedures were successful. In 16 acute dissections the indications were malperfusion syndrome or unmanageable hypertension in seven patients and imminent rupture or persistent pain in nine. Twenty chronic patients were operated due to dilatation (mean 6 cm). One patient died due to cardiac failure. One patient had a transient paraparesia and two had pulmonary embolism. No patient died in a follow up period ranging from 2.5 to 74 months. Four patients required a new aortic endovascular procedure due to progressive dilatation or endoleak.


CONCLUSIONS
Endovascular treatment of type B aortic dissection has good immediate and long term results.
Mertens
Renato
R
Departamento de Cirugía Vascular y Endovascular, División de Cirugía, Pontificia Universidad Católica de Chile. rmertens@manquehue.net
Arriagada
Ivette
I
Valdés
Francisco
F
Krämer
Albrecht
A
Mariné
Leopoldo
L
Bergoeing
Michel
M
Braun
Sandra
S
Godoy
Iván
I
Córdova
Samuel
S
Huete
Alvaro
A
Vergara
Jeannette
J
Carvajal
Claudia
C
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002908:Chronic Disease; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome