title: Chronic dissection - indications for treatment with branched and fenestrated stent-grafts.
abstract: The treatment of chronic aortic dissection is a major challenge for the vascular surgeon. Close imaging follow-up after the acute episode frequently identifies dilation of untreated aortic segments. Aortic dissection often extends to both the supra-aortic trunks and to the visceral aorta. The poor medical condition that often characterizes these patients may preclude extensive open surgical repair. Recent advances in endovascular techniques provide a valid alternative to open surgery. These complex lesions can now be managed using thoracic branched and fenestrated endografts. However, clinical data are scarce and only 3 small series from 3 high-volume aortic centers are currently available. Careful anatomical study on 3D workstations is mandatory to select patients that are candidates for complex endovascular exclusion; a specific focus on the available working space within the true lumen, extension to the arch and/or the visceral/renal arteries, and false lumen perfusion of visceral vessels is required. An excellent understanding of those anatomic details demands high-quality preoperative CTA. Intraoperative advanced imaging applications are a major adjunct in the achievement of technical success.
authors: Aortic Centre, Hôpital Cardiologique CHRU Lille, France - stephan.haulon@chru-lille.fr.
authors: J
authors: J
authors: Sobocinski
authors: R
authors: R
authors: Spear
authors: M R
authors: MR
authors: Tyrrell
authors: B
authors: B
authors: Maurel
authors: T
authors: T
authors: Martin Gonzalez
authors: A
authors: A
authors: Hertault
authors: M
authors: M
authors: Midulla
authors: R
authors: R
authors: Azzaoui
authors: S
authors: S
authors: Haulon
mesh_terms: D000784:Aortic Dissection / Q000175:diagnosis / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D002908:Chronic Disease; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D018579:Patient Selection; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012307:Risk Factors; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome