Revolutionary treatment of aneurysms and dissections of descending aorta: the endovascular approach (original) (raw)
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Self-expandable aortic stent-grafts for treatment of descending aortic dissections
The Annals of Thoracic Surgery, 2002
Acute aortic dissection is a life-threatening medical condition that is associated with high morbidity and mortality. Of 198 patients treated with a self-expanding polyester-covered stent-graft for various pathologic aortic conditions in our institution, we selected 70 consecutive patients with type B aortic dissection who were undergoing treatment. The stent-graft was introduced through the femoral artery in the angiography suite, under general anesthesia with systemic heparinization and induced hypotension. The procedure was performed in 70 patients; of these, 58 had descending aortic dissection and 12 had atypical dissections. The procedure was successful in 65 patients (92.9%), as documented by exclusion of the false lumen of the thoracic aorta. Eleven patients (18.9%) had persistent blood flow in the false lumen of the abdominal aorta due to distal reentries. Five patients (7.1%) underwent conversion to surgery. Insertion of additional stent-grafts was required in 34 patients (48.6%). At 29 months of follow-up, 91.4% of the patients were alive. Stent-grafts are an important means of treating aortic dissections, which may replace conventional medical treatment of this condition for the majority of patients.
Stent grafting for aneurysmal degeneration of chronic descending thoracic aortic dissections
Journal of Vascular Surgery, 2012
Objective: The objective of this study was to examine the results of thoracic endovascular aneurysm repair (TEVAR) for chronic descending thoracic aortic (DTA) dissections with aneurysmal degeneration. Methods: Over 70 months at a single institution, 27 patients underwent TEVAR for aneurysms related to chronic (>6 weeks) DTA dissections. Results: Mean patient age was 67.5 ؎ 9.6 years; 18 were men. Primary indications for repair were aneurysm size (n ؍ 20), rapid aneurysmal growth (n ؍ 5), saccular aneurysm (n ؍ 1), and rupture (n ؍ 1). Preoperative false lumen status was patent in 18 patients, partially thrombosed in 8 patients, and unknown in the patient whose aneurysm ruptured. The proximal entry tear was covered in all 27 patients. Fourteen patients required coverage of the left subclavian artery, of which 9 patients underwent prophylactic revascularization. On completion angiogram, no patient had antegrade perfusion of the aneurysmal false lumen. There were three procedural complications: 2 patients sustained paraparesis (one resolved and one improved), and 1 patient had an access injury requiring stent graft placement. Thirty-day mortality was 3.7% (1 of 27); the one death was in the patient whose aneurysm ruptured. Of the 26 surviving patients, 23 (88.5%) had thrombosis of the aneurysmal false lumen. Twenty-two patients (84.6%) had stability or decrease in maximal aneurysm diameter on last radiographic follow-up at 18 ؎ 20 months. Three-year Kaplan-Meier survival was 90.3% ؎ 6.5% in the 26 patients who survived to hospital discharge, with a mean follow-up of 27.3 ؎ 22.1 months. In patients with preoperatively partially thrombosed false lumens (n ؍ 8), 3-year survival was 100%. Conclusions: TEVAR for aneurysms due to chronic dissections of the DTA can be performed safely and effectively at midterm follow-up according to this single-institution study. Stent graft therapy may be of particular benefit in patients presenting with partially thrombosed false lumens. ( J Vasc Surg 2012;55:963-7.)
Endovascular stent graft repair for aneurysms on the descending thoracic aorta
The Annals of Thoracic Surgery, 1998
Background. The traditional treatment of aneurysms of the descending thoracic aorta includes posterolateral thoracotomy and aortic replacement with a prosthetic graft. In this study, we report our experiences and results in endovascular stent graft placement as an alternative to surgical repair.
Endovascular treatment of complicated type-B aortic dissection with stent-grafts: …
Journal of Vascular and …, 2003
To report the midterm results of the endovascular treatment of complicated type-B aortic dissection with use of stent-grafts. MATERIALS AND METHODS: Ten patients with acute (n ؍ 4) or chronic (n ؍ 6) complicated type-B dissection were treated with custom-made stent-grafts. Indications for treatment included uncontrollable hypertension with dissection extension (n ؍ 3), renal ischemia (n ؍ 1), and false lumen aneurysm (n ؍ 6). Stainless-steel Z-stents covered with polyester grafts were placed in the initial six patients. Nitinol stents covered with ultrathin polytetrafluoroethylene were used in the remaining four patients. The patients were followed-up with helical computed tomography for a maximum of 30 months (mean, 20 mo). RESULTS: There was one technical failure related to the access site. Early complications included deep venous thrombosis (n ؍ 1) and embolic stroke (n ؍ 1). Complete thrombosis of the thoracic false lumen was achieved in six patients and partial thrombosis was achieved in three. Aneurysms developed at the ends of the stainless-steel stents in two patients, requiring additional stent-graft placement. Despite successful remodeling of the thoracic aorta, three of four patients with distal reentry into the abdominal aorta experienced progressive abdominal aortic aneurysm (AAA). AAA rupture developed in two patients; one rupture was fatal and the other was treated with emergency surgery. CONCLUSIONS: Endovascular treatment of complicated type-B aortic dissection is technically feasible and effective. Closely monitoring the treated aorta is essential to detect early aneurysm formation at the ends of rigid stents. Despite adequate sealing of the tears in the thoracic aorta, dissection with distal reentry phenomenon into the abdominal aorta may evolve into AAA with late rupture.
Endovascular Treatment of Descending Thoracic Aortic Aneurysms and Dissections
The Surgical clinics of North America, 1999
Various endovascular techniques have become viable therapeutic alternatives in the treatment of patients with many types of descending thoracic aortic pathology and aortic dissections. Descending thoracic aortic aneurysms can be successfully treated using stent grafts. This technique is ...
Journal of Vascular Surgery, 2004
Purpose: The advent of endovascular prostheses to treat descending thoracic aortic lesions offers an alternative approach in patients who are poor candidates for surgery. The development of this approach includes complications that are common to the endovascular treatment of abdominal aortic aneurysms and some that are unique to thoracic endografting. Methods: We conducted a retrospective review of 60 emergent and high-risk patients with thoracic aortic aneurysms (TAAs) and dissections treated with endovascular prostheses over 4 years under existing investigational protocols or on an emergent compassionate use basis. Results: Fifty-nine of the 60 patients received treatment, with one access failure. Thirty-five patients received treatment of TAAs. Four of these procedures were performed emergently because of active hemorrhage. Twenty-four patients with aortic dissections (16 acute, 8 chronic) also received treatment. Eight of the patients with acute dissection had active hemorrhage at the time of treatment. Three devices were used: AneuRx (Medtronic; n ؍ 31), Talent (Medtronic; n ؍ 27), and Excluder (Gore; n ؍ 1). Nineteen secondary endovascular procedures were performed in 14 patients. Most were secondary to endoleak (14 of 19), most commonly caused by modular separation of overlapping devices (n ؍ 8). Other endoleaks included 4 proximal or distal type I leaks and 2 undefined endoleaks. The remaining secondary procedures were performed to treat recurrent dissection (n ؍ 1), pseudoaneurysm enlargement (n ؍ 3), and endovascular abdominal aortic aneurysm repair (n ؍ 1). One patient underwent surgical repair of a retrograde ascending aortic dissection after endograft placement. Procedure-related mortality was 17% in the TAA group and 13% in the dissection group, including 2 acute retrograde dissections that resulted in death from cardiac tamponade. Overall mortality was 28% at 2-year follow-up.
Endovascular Treatment of Complicated Type-B Aortic Dissection with Stent-Grafts: Midterm Results
Journal of Vascular and Interventional Radiology, 2003
PURPOSE: To report the midterm results of the endovascular treatment of complicated type-B aortic dissection with use of stent-grafts. MATERIALS AND METHODS: Ten patients with acute (n ؍ 4) or chronic (n ؍ 6) complicated type-B dissection were treated with custom-made stent-grafts. Indications for treatment included uncontrollable hypertension with dissection extension (n ؍ 3), renal ischemia (n ؍ 1), and false lumen aneurysm (n ؍ 6). Stainless-steel Z-stents covered with polyester grafts were placed in the initial six patients. Nitinol stents covered with ultrathin polytetrafluoroethylene were used in the remaining four patients. The patients were followed-up with helical computed tomography for a maximum of 30 months (mean, 20 mo).