title: Perioperative and mid-term results of endovascular management of complicated type B aortic dissection using a proximal thoracic endoprosthesis and selective distal bare stenting.
abstract: OBJECTIVE
  To present results of endovascular treatment of complicated type B aortic dissection.
  
  
  METHODS
  Patients with acutely complicated type B aortic dissection extending from the left sub-clavian artery to the abdominal aorta were treated. The strategy involved the placement of a covered endoprosthesis to seal the primary entry tear and, in cases where malperfusion persisted, distal extension with uncovered stents, to enhance true lumen (TL) expansion and reperfusion of the ischaemic arterial branches originating from the TL.
  
  
  RESULTS
  Thirty-five patients were included. Mean age was 63.1 (37-79) years and malperfusion syndrome occurred in 71.4%. Average aortic coverage with endoprostheses was 220.6 mm (136-355 mm). In 17 cases (48.5%), distal extension with uncovered stents was necessary. Thirty-day major morbidity was 28.5%, and mortality 2.8%. At follow-up (25.6 ± 19.5 months; 4-73 months), overall mortality was 15.2%, and aortic mortality 12.1%. Additional aortic intervention was necessary in 18.2%. Although patients undergoing distal extension with bare metal stents suffered most often from preoperative malperfusion, no significant differences were noted in the 30-day and follow-up clinical results. Follow-up angio-computed tomography showed complete thrombosis of the false lumen in the proximal half of the thoracic aorta in 76.4%. Patients treated with bare stents had significantly larger aortic TL sizes, at the different abdominal aorta levels.
  
  
  CONCLUSIONS
  In patients with complicated type B aortic dissection, tailored elongation with uncovered stents is a safe treatment of persistent malperfusion. Although the results presented are encouraging, randomized data and a longer follow-up are required to confirm benefits and complications of this strategy.
authors.affiliation: Department of Cardiology and Cardiac Intervention, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany Rostock University Medical Center, Rostock, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Kische
authors.affiliation: Department of Cardiology and Cardiac Intervention, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany Rostock University Medical Center, Rostock, Germany rgea@hotmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Ancona
authors.affiliation: Department of Cardiology and Cardiac Intervention, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany Rostock University Medical Center, Rostock, Germany.
authors.forename: Ioan Christian
authors.initials: IC
authors.lastname: Belu
authors.affiliation: Department of Cardiology and Cardiac Intervention, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany Rostock University Medical Center, Rostock, Germany.
authors.forename: Yannik
authors.initials: Y
authors.lastname: Stoeckicht
authors.affiliation: Department of Cardiology and Cardiac Intervention, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany Rostock University Medical Center, Rostock, Germany.
authors.forename: Umut
authors.initials: U
authors.lastname: Agma
authors.affiliation: Department of Cardiology and Cardiac Intervention, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany Rostock University Medical Center, Rostock, Germany.
authors.forename: Jasmin
authors.initials: J
authors.lastname: Ortak
authors.affiliation: Department of Cardiology and Cardiac Intervention, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany Rostock University Medical Center, Rostock, Germany.
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Ince
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D015331:Cohort Studies; D057510:Endovascular Procedures / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015607:Stents; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aortic dissection type B; Bare metal; Endovascular stent