title: Uncovered stent implantation in complicated acute aortic dissection type B.
abstract: OBJECTIVE
  To retrospectively evaluate the technical feasibility and midterm results of uncovered thoracoabdominal stent placement in complicated acute aortic dissection Stanford type B (cAADB).
  
  
  METHODS
  Fourteen consecutive patients (3 females; range, 44-71 years) with cAADB who had symptomatic gastrointestinal malperfusion and claudication underwent immediate uncovered stent implantation (diameter, 7-28 mm; length, 40-100 mm) into the true lumen of the thoracoabdominal aorta (n = 23) and visceral arteries (n = 5).
  
  
  RESULTS
  Stenting resulted in elimination of gastrointestinal ischemia and symptoms in 13 of 14 patients; persisting symptoms led to secondary surgical revascularization in only 1 patient. More than 1 stent (≤ 4) was placed in 7 patients (2 celiac, 1 mesenteric, 2 renal, 8 aorto-iliac). Follow-up computed tomographic angiography (CTA) revealed collapse of 4 aortic stents (diameter, 9-25 mm; length, 100 mm) at 1 week in the absence of symptoms. Balloon reexpansion was possible in all 4 stents, but recollapse occurred within 1 month. Despite stent collapse, the patients remained asymptomatic; ultrasonography and CTA documented sufficient perfusion of the visceral arteries in all patients. Follow-up ranged from 6 months to 5 years (average, 2.5 years). Except for the patient who underwent iliacomesenteric bypass for unspecific abdominal pain, no other patient required additional interventional or surgical therapy.
  
  
  CONCLUSIONS
  Acute aortic dissection with suspicion of visceral ischemia should prompt for immediate intervention. Thoracoabdominal uncovered stent implantation is a technically feasible and effective minimally invasive approach that provided successful relief of acute visceral ischemia and claudication in cAADB. Stent size should be less than the normal aortic diameter to avoid possible stent collapse.
authors.affiliation: Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany. Electronic address: alexander.massmann@uks.eu.
authors.forename: Alexander
authors.initials: A
authors.lastname: Massmann
authors.affiliation: The Cardiovascular Institute, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kunihara
authors.affiliation: Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Fries
authors.affiliation: Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany.
authors.forename: Günther
authors.initials: G
authors.lastname: Schneider
authors.affiliation: Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany.
authors.forename: Arno
authors.initials: A
authors.lastname: Buecker
authors.affiliation: Clinic of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany.
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Schäfers
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000503:physiopathology; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014781:Viscera / Q000098:blood supply*