title: Endovascular repair of Stanford B aortic dissection using two stent grafts with different sizes.
abstract: OBJECTIVE
  The objective of this study was to introduce a novel strategy for thoracic endovascular aortic repair of Stanford B aortic dissection using two-stent graft implantation (TSI), in which the proximal stent and distal stent with different sizes are sequentially deployed, and to summarize our experience with this technique.
  
  
  METHODS
  A retrospective study was conducted of 72 consecutive patients (61 men; mean age, 55 ± 7 years; range, 41-67 years) with Stanford type B aortic dissection who underwent TSI treatment between January 2012 and May 2013. Among all patients, 43 (59.7%) involved the infrarenal aorta and 29 (40.3%) involved the whole thoracic and abdominal aorta; mean aortic involvement length was 226 ± 13 mm (range, 182-312 mm). Eight cases were for acute dissection (within 2 weeks from onset of symptoms), 11 cases were for chronic dissection (>3 months after initial dissection), and 53 cases were for subacute dissection (between 2 weeks and 3 months). Twenty-two cases (30.6%) were uncomplicated type and 50 cases (69.4%) were complicated type. Follow-up was performed postoperatively at 1 month, 6 months, and yearly thereafter. Technique success, aorta morphology, and procedure-related complications were evaluated.
  
  
  RESULTS
  Technical success was achieved in 100%; 72 pairs of stent grafts (144 thoracic stent grafts) and 10 left subclavian artery chimney stents were used. The mean aortic length coverage by the stent grafts was 197.6 ± 20.3 mm, and mean taper diameter span was 7.5 ± 1.8 mm. All patients were followed up from 6 to 16 months (mean, 10 ± 4 months); 95.8% (69 of 72) had a thrombosed false lumen in the aortic coverage, and the true lumen expanded on average 57% ± 11% (23%-100%). No significant changes were found in aortic diameters of the proximal and distal ends of the two stent grafts and the angles between centerlines of the distal end of the stent and the aorta during follow-up. Procedure-related complications included transient paraplegia (coverage of the left subclavian artery without revascularization and extensive coverage of aorta >220 mm) due to acute spinal cord ischemia (n = 1) and malapposition of the distal stent (primary tear closed, true lumen expansion led to oversize rate insufficient in distal stent diameter; n = 1). No death or malperfusion complications were observed during the perioperative period and follow-up.
  
  
  CONCLUSIONS
  Short-term outcomes showed TSI to be a flexible and effective approach to accurately repair Stanford B aortic dissection that could potentially address the limitations of currently available stent grafts. Further prospective clinical studies are warranted to evaluate its long-term efficacy.
authors.affiliation: Department of Intervention, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Xiaoyong
authors.initials: X
authors.lastname: Huang
authors.affiliation: Department of Intervention, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. Electronic address: huanglianjun2008@163.com.
authors.forename: Lianjun
authors.initials: L
authors.lastname: Huang
authors.affiliation: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Lizhong
authors.initials: L
authors.lastname: Sun
authors.affiliation: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Shangdong
authors.initials: S
authors.lastname: Xu
authors.affiliation: Department of Intervention, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Yuguo
authors.initials: Y
authors.lastname: Xue
authors.affiliation: Department of Intervention, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Qinglong
authors.initials: Q
authors.lastname: Zeng
authors.affiliation: Department of Intervention, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Xi
authors.initials: X
authors.lastname: Guo
authors.affiliation: Department of Intervention, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Mingliang
authors.initials: M
authors.lastname: Peng
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000601:surgery*; D015901:Angiography, Digital Subtraction; D017545:Aortic Aneurysm, Thoracic / 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*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome