Assessment of abdominal branch vessel patency after bare-metal stenting of the thoracoabdominal aorta in a human ex vivo model of acute type B aortic dissection.
OBJECTIVE
The purpose of this study was to assess the efficiency of bare-metal stenting of the thoracoabdominal aorta in a human ex vivo model of acute type B aortic dissection and the impact of this approach on the patency of the visceral and renal arteries.


METHODS
Fifteen human cadaveric aortas were harvested. Type B aortic dissections were surgically initiated 2 cm below the left subclavian artery. Aortas were thereafter connected to a bench top pulsatile flow to induce propagation of the dissection. A 5-mm 30° lens (Richard Wolf, Vernon Hills, Ill) was introduced successively into the false lumen and the true lumen to monitor the propagation of the dissection. Bare-metal stents were deployed into the true lumen from the primary entry tear to the infrarenal aorta. Measurement of systolic pressure was taken within the abdominal branch vessels before and after stenting. A pressure gradient drop of 15 mm Hg or more after bare-metal stenting was considered hemodynamically relevant.


RESULTS
Dissection was propagated at least to the renal aorta in 11 cases (73%) and to the infrarenal aorta in 3 cases (20%). Of the 60 abdominal branch vessels studied, 22 (36.7%) were supplied by the false lumen. After extensive aortic bare-metal stenting, complete reattachment of the dissection flap was observed in all cases. Regarding visceral and renal artery patency after bare-metal stenting, a significant pressure gradient drop was reported in 54.5% (n = 12) when these arteries were supplied by the false lumen, whereas those originating from the true lumen had a significantly less common pressure gradient drop (7.9% [n = 3]; P < .0001).


CONCLUSIONS
Bare-metal stenting in this model of acute type B aortic dissection was effective in true lumen reexpansion but induced a high (54.5%) rate of significant pressure drop in the visceral and renal arteries when they were supplied by the false lumen.
Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France; Laboratory of Experimental Surgery, Lapeyronie Hospital, Montpellier, France; INSERM U1046, University of Montpellier 1, CHRU of Montpellier, Montpellier, France. Electronic address: elsafaure@hotmail.com.
Elsa Madeleine
EM
Faure
Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France; Laboratory of Experimental Surgery, Lapeyronie Hospital, Montpellier, France; INSERM U1046, University of Montpellier 1, CHRU of Montpellier, Montpellier, France.
Ludovic
L
Canaud
Legal Department, Lapeyronie Hospital, Montpellier, France.
Philippe
P
Cathala
Department of Anatomopathology, Lapeyronie Hospital, Montpellier, France.
Isabelle
I
Serres
Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.
Charles
C
Marty-Ané
Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France; Laboratory of Experimental Surgery, Lapeyronie Hospital, Montpellier, France; INSERM U1046, University of Montpellier 1, CHRU of Montpellier, Montpellier, France.
Pierre
P
Alric
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000503:physiopathology / Q000628:therapy*; D001014:Aortic Aneurysm / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D012077:Renal Artery / Q000503:physiopathology; D015607:Stents; D014654:Vascular Patency / Q000502:physiology*; D014781:Viscera / Q000098:blood supply