title: Perioperative aortic dissection rupture after endovascular stent graft placement for treatment of type B dissection.
abstract: BACKGROUND
  The perioperative aortic dissection (AD) rupture is a severe event after endovascular stent graft placement for treatment of type B AD. However, this life-threatening complication has not undergone systematic investigation. The aim of the study is to discuss the reasons of AD rupture after the procedure.
  
  
  METHODS
  The medical record data of 563 Stanford type B AD patients who received thoracic endovascular repair from 2004 to December 2011 at our institution were collected and analyzed. Double entry and consistency checking were performed with Epidata software.
  
  
  RESULTS
  Twelve patients died during the perioperation after thoracic endovascular repair, with an incidence of 2.1%, 66.6% were caused by aortic rupture and half of the aortic rupture deaths were caused by retrograde type A AD. In our study, 74% of the non-rupture surviving patients had the free-flow bare spring proximal stent implanted, compared with 100% of the aortic rupture patients (74% vs. 100%, P = 0.213). The aortic rupture patients are more likely to have ascending aortic diameters = 4 cm (62.5% vs. 9.0%, P = 0.032), involvement the aortic arch concavity (62% vs. 27%, P = 0.041) and have had multiple stents placed (P = 0.039).
  
  
  CONCLUSIONS
  Thoracic AD endovascular repair is a safe and effective treatment option for AD with relative low in-hospital mortality. AD rupture may be more common in arch stent-graft patients with an ascending aortic diameter = 4 cm and with severe dissection that needs multi-stent placement. Attention should be paid to a proximal bare spring stent that has a higher probability of inducing an AD rupture. Post balloon dilation should be performed with serious caution, particularly for the migration during dilation.
authors: Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China.
authors: Wen-hui
authors: WH
authors: Huang
authors: Song-yuan
authors: SY
authors: Luo
authors: Jian-fang
authors: JF
authors: Luo
authors: Yuan
authors: Y
authors: Liu
authors: Rui-xin
authors: RX
authors: Fan
authors: Ling
authors: L
authors: Xue
authors: Fang
authors: F
authors: Yang
authors: Hui-yuan
authors: HY
authors: Kang
authors: Meng-nan
authors: MN
authors: Gu
authors: Zhen
authors: Z
authors: Liu
authors: Nian-jin
authors: NJ
authors: Xie
authors: Hao-jian
authors: HJ
authors: Dong
authors: Zhong-han
authors: ZH
authors: Ni
authors: Mei-ping
authors: MP
authors: Huang
authors: Ji-yan
authors: JY
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents