Fenestrated and branched stent-grafts to treat post-dissection chronic aortic aneurysms after initial treatment in the acute setting.
OBJECTIVE
To present our initial experience treating post-dissection thoracoabdominal aneurysms with fenestrated and branched grafts.


METHODS
Six patients (all men; mean age 62 years, range 44-71) with post-dissection thoracoabdominal aortic aneurysms were selected for treatment with fenestrated and branched grafts. All patients were initially treated with open surgery or endovascular treatment for their acute dissection. In total, 21 visceral arteries were targeted (3 celiac arteries, 6 superior mesenteric arteries, 12 renal arteries).


RESULTS
Technical success was achieved in all cases, with no mortality or paraplegia. At completion angiography, all target vessels were patent, and no type I endoleak was seen. A type II endoleak was present in 4 patients, with the false lumen still partially perfused. During follow-up (mean 9 months, range 3-15), no patients died. One targeted renal artery occluded at 1 month. One type Ib endoleak in a left renal artery was successfully treated with additional stenting. Five of the 6 patients had a 6-month follow-up. On abdominal ultrasound, 3 type II endoleaks were still seen. In 2 of these patients, the endoleak was resolved, the false lumen was completely thrombosed, and the maximum aortic diameter had regressed on the 1-year CTA.


CONCLUSIONS
Although longer follow-up results are needed, treatment with fenestrated and branched stent-grafts seems feasible and may be a promising option for the treatment of chronic post-dissection aortic aneurysms.
Department of Vascular and Endovascular Surgery, Klinikum Nürnberg, Germany. eric.verhoeven@klinikum-nuernberg.de
Eric L
EL
Verhoeven
Kosmas I
KI
Paraskevas
Kyriakos
K
Oikonomou
Ozan
O
Yazar
Wolfgang
W
Ritter
Karin
K
Pfister
Piotr
P
Kasprzak
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D002908:Chronic Disease; D057867:Endoleak / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome