Endovascular treatment of chronic aortic dissection.
The optimal management of chronic aortic dissection is uncertain. Traditional strategies of best medical management for asymptomatic lesions and open surgical intervention for evolving complications have been challenged in the endovascular era. The concept of minimally invasive surgery in this high risk patient group is appealing. Endovascular stent graft deployment targets closure of the dissection entry tear. This can induce false lumen thrombosis, reducing risk of disease progression and aortic rupture. Initial reports were encouraging with a high level of technical success. However, long-term data demonstrating durability and improved survival are lacking. There remain no clear guidelines for the application of this technology. Its role as an adjunct to best medical therapy for uncomplicated dissections or an alternative to open surgery in complicated disease is yet to be elucidated. This review presents the current evidence for endovascular management of chronic aortic dissection.
Nordon
I M
IM
St George's Vascular Institute, St James' Wing, St George's Hospital, Blackshaw Road, London SW17 0QT, UK. inordon@sgul.ac.uk
Yates
M T
MT
Hinchliffe
R J
RJ
Holt
P J
PJ
Loftus
I M
IM
Thompson
M M
MM
D000784:Aortic Dissection / Q000150:complications / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D002908:Chronic Disease; D006801:Humans; D007511:Ischemia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D013116:Spinal Cord / Q000098:blood supply; D015607:Stents