Complicated type B aortic dissection should not be treated with uncovered stents: a lesson not yet learned.
Whenever some basic rules for endovascular aortic repair of type B aortic dissection are not followed, iatrogenic complications may develop. A 64-year-old gentleman was referred to our institution for revision of previous treatment of complex type B aortic dissection with 2 bare stents. At 3 months, the most proximal aortic bare stent had entered, via the proximal tear, the false lumen. Aortic expansion and dynamic obstruction at the level of the renal arteries had also developed. In a first step, we removed the proximal aortic bare stent surgically. Few days later, 2 covered endografts were implanted into the true lumen of the thoracic aorta with clinical success. The rationale for using endovascular treatment in patients with complicated type B aortic dissection is coverage of the entry tear with covered nonoversized endografts. Negative results are achieved whenever these very simple rules are not strictly followed.
Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany; Rostock University Medical Center, Rostock, Germany.
Stephan
S
Kische
Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany; Rostock University Medical Center, Rostock, Germany. Electronic address: rgea@hotmail.com.
Giuseppe
G
D'Ancona
Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany; Rostock University Medical Center, Rostock, Germany.
Jasmin
J
Ortak
Rostock University Medical Center, Rostock, Germany.
Benjamin
B
Bermaoui
Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany; Rostock University Medical Center, Rostock, Germany.
Yannik
Y
Stoeckicht
Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany; Rostock University Medical Center, Rostock, Germany.
Hüseyin
H
Ince
D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation*; D020878:Device Removal; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012086:Reoperation; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome