title: Emergency endovascular stent-grafting for acute type B aortic dissection with symptomatic malperfusion.
abstract: OBJECTIVE
  The aim of this paper was to analyze the durability and efficacy of emergency thoracic endovascular aortic repair (TEVAR) for acute Stanford type B aortic dissection (TBAD) with malperfusion syndrome.
  
  
  METHODS
  A retrospective analysis of acute TBAD with spinal cord, kidney, viscera, and extremity malperfusion was performed. Emergency TEVAR to cover primary tear site by stent-graft was strongly suggested to included candidates. Computed tomography (CT) scans and clinical findings were carried out in diagnosis and follow-up.
  
  
  RESULTS
  One hundred twenty-seven TBAD patients (101 men, 46.1±11.4 year, range 34~76) who presented with acute end-organ malperfusion, including sudden paraplegia (N.=4), acute renal failure (N.=26), acute viscera ischemia (N.=61) and limb ischemia (N.=36), received aortic stent-grafting 2~48 hours after onset. Technical success was achieved in all primary TEVAR. The overall endoleak rate was 7.1% (9/127; typeI:3; typeII: 4; typeIV: 2). The 30-day mortality was 0.8% (2/127). 125 patients were followed for 19.1±14.5 (1~86) months, one patient died 50 days post-TEVAR due to myocardial infarction. Four patients required reintervention with additional stent grafts. Follow-up CT angiography showed enlargement of the true lumen and different degrees of thrombosis in the distal false lumen (complete thrombosis in 48, partial thrombosis in 52 and patency in 24).
  
  
  CONCLUSIONS
  Emergency TEVAR is an effective method to treat acute TBAD complicated with end-organ malperfusion. Covering of the proximal entry site of TBAD by stent-graft leads to flow increased in the true lumen and thrombosis of the false lumen of varying degree, which may improve end-organ perfusion and restore branch vessels patency.
authors.affiliation: Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China. changshu0101@gmail.com
authors.forename: C
authors.initials: C
authors.lastname: Shu
authors.forename: K
authors.initials: K
authors.lastname: Fang
authors.forename: M
authors.initials: M
authors.lastname: Luo
authors.forename: Q
authors.initials: Q
authors.lastname: Li
authors.forename: Z
authors.initials: Z
authors.lastname: Wang
mesh_terms: D000208:Acute Disease; D058186:Acute Kidney Injury / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D004630:Emergencies; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency