The future of stenting in patients with type A aortic dissection: a systematic review (original) (raw)
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European Journal of Vascular and Endovascular Surgery, 2013
Endovascular treatment seems to be a potential option in patients with type A dissection at prohibitive risk for open surgery. At the moment there are only few reports in the literature and the technique is not standardised. This article underlines a preoperative study method and an operative technique. We hope it may be useful for surgeons approaching this new endovascular frontier. Background: Open repair is the gold standard for type A aortic dissection (TAAD). Endovascular option has been proposed in very limited and selected TAAD patients. We report our experience with endovascular TAAD repair. Methods: Inclusion criteria were: (1) entry tear in the ascending aorta; (2) proximal landing zone of at least 2 cm; (3) distance between entry tear and brachio-cephalic trunk of at least 0.5 cm; (4) no signs of cardiac tamponade or severe aortic regurgitation and (5) no signs of aortic branches ischaemia. Patients with cardiac revascularisation from ascending aorta were excluded. Results: From April 2009 to June 2012, 37 patients with TAAD were admitted to our hospital. As many as 28 underwent surgical repair and 9 were considered at high surgical risk in a multidisciplinary meeting. Four met our inclusion criteria for an endovascular approach. Two of them had previous ascending aortic repair for TAAD and one had aortic valve replacement. Technical success was achieved in 100% of the patients. No mortality was registered during a median follow-up of 15 months (range 4e39 months), no migration of the graft and complete false lumen thrombosis of the ascending aorta in three patients. Conclusion: Endovascular treatment of TAAD is challenging but feasible in a selected subset of patients. Further research remains mandatory.
Combined Surgical and Endovascular Treatment of Acute Aortic Dissection Type A
The Annals of Thoracic Surgery, 2002
Methods. From April 2001 to February 2002, 8 consecutive patients (3 women [37.5%] and 5 men [62.5%]) with a mean age of 55.7 years (range, 45 to 70 years) were intended to be treated with the combined method of surgical repair of the ascending aorta and transluminal stent ...
2019
Type A Aortic Dissection (TAAD) is a critical medical condition which requires emergent surgical intervention. Here we present a complex clinical case (done 17 years ago) of acute TAAD, which received lifesaving endovascular intervention immediately after primary surgical treatment. Due to complicated dissection with additional tears and extreme true lumen compression, the postoperative physical condition of the patient was rapidly worsening, which posed the question for immediate resolution of the life-threatening symptoms. Endovascular treatment with non-covered stents implantation in the compressed true aortic lumen lead to immediate visceral and renal ischemia improvement and excellent post-procedural clinical course. This initial experience proved that in critically ill patients with complicated aortic dissection with visceral and renal ischemia endovascular treatment with non-covered stents implantation can be a low-risk, successful and durable alternative method of treatment.
Combined Open and Endovascular Repair of Acute Type A Aortic Dissection
The Annals of Thoracic Surgery, 2007
ment was successful in terms of inducing aneurysmal sac shrinkage. As we used new generation stent grafts for redo stent-graft placement in both patients, we feel that the risk for re-expansion of the aneurysmal sac is reduced to a minimum. In summary, endovascular redo stent-graft placement may represent an effective means in treating type V endoleaks by inducing aneurysmal sac shrinkage. Extended application of this approach may aid in treating this particular subgroup of patients as an alternative to conventional repair. Further observations are warranted to reconfirm durability of this approach. References 1. Kazui T, Washiyama N, Muhammad BA, et al. Improved results of atherosclerotic arch aneurysm operations with a refined technique.
Endovascular Approaches to Acute Aortic Type A Dissection: A CT-Based Feasibility Study
European Journal of Vascular and Endovascular Surgery, 2011
Open graft replacement of the ascending aorta is the current treatment of choice for Stanford acute type A dissections. However, approximately 20% of patients are deemed unfit for open surgery. To determine if an endovascular option exists for this latter group of patients, we performed a computed tomography (CT)-based feasibility study. A cohort of consecutive patients presenting to the cardiovascular care unit (CVCU) for an acute Stanford type A aortic dissection between 2006 and 2009 was retrospectively analysed. Inclusion criterion was a high-quality preoperative angio-CT scan that could be analysed on a three-dimensional (3D) workstation. Numerous anatomical parameters of the dissection were studied, including the location and the length of the primary proximal entry tear. Finally, we determined which of the patients would have been potential candidates for an endovascular repair (stentgraft implantation). A total of 102 patients were included in our study. The median distance of the primary entry tear to the closest coronary artery was 23 mm (range 0-128). The median true lumen and true + false lumen (total) diameters at the level of the entry tear was 38 mm (range 22-78) and 46 mm (range 28-93), respectively. The median length of the ascending aorta was 84 mm (range 40-130). An endovascular repair with a tubular stentgraft was deemed feasible in 37 patients. An additional eight patients were also candidates for a tubular endovascular repair but would have required a carotidecarotid cross over bypass. Finally, an arch-branched stentgraft could have been used in 13 patients to exclude an entry tear located in the arch. Open repair of acute type A dissection is and remains the 'gold standard' of care. Our study demonstrates that approximately half the patients undergoing an open repair could potentially benefit from an endovascular repair. This new treatment option has not been evaluated to date.
Combined interventional and surgical treatment for acute aortic type a dissection
International Journal of Surgery, 2008
Background: Surgical repair and endovascular stent-graft placement are both therapies for thoracic aortic dissection. A combination of these two approaches may be effective in patients with type A dissection. In this study, we evaluated the prognosis of this combined technique. Methods: From December 2003 to December 2006, 15 patients with type A dissection were admitted to our institute; clinical data were retrospectively reviewed. Follow-up was performed at discharge and approximately 12 months after operation. Results: Endovascular stent-graft placement by interventional radiology and surgical repair for reconstruction of aortic arch was performed in all patients. Total arch replacement for distal arch aneurysm was carried out under deep hypothermia with circulatory arrest; antegrade-selected cerebral perfusion was used for brain protection. Four patients concomitantly received a coronary artery bypass graft. Hospital mortality rate was 6.7%; the patient died of cerebral infarction. Neural complications developed in two patients. Multi-detector-row computed tomography scans performed before discharge revealed complete thrombosis of the false lumen in six patients and partial thrombosis in eight patients. At the follow-up examination, complete thrombosis was found in another three patients, aortic rupture, endoleaks or migration of the stent-graft was not observed and injuries of peripheral organs or anastomotic endoleaks did not occur. Conclusions: For patients with aortic type A dissection, combining intervention and surgical procedures is feasible, and complete or at least partial thrombosis of the false lumen in the descending aorta can be achieved. This combined approach simplified the surgical procedures and shortened the circulatory arrest time, minimizing the necessity for further aortic operation.
Circulation Journal, 2017
Background: The aims of the present study were to analyze the anatomical characteristics of type A aortic dissections (TAAD) in Japanese patients and evaluate the feasibility of 3 next-generation stent grafts dedicated to ascending/arch aortic lesions. Methods and Results: We analyzed 172 consecutive patients surgically treated for TAAD at 2 institutions between 2007 and 2015. Computed tomography (CT) images and operative records were used to identify the location of entry tear (ET). The anatomical feasibility of the Zenith Ascend, Zenith A-branch, and TAG Thoracic Branch Endoprosthesis (TBE) was evaluated using the manufacturers' instructions for use (IFU). In total, 131 patients were included in the final analysis. Dissection was present at the sinotubular junction (STJ) in 107 patients (81.7%), and the mean diameter of the STJ was 39.4±6.0 mm. The ET was at the STJ (n=33), ascending aorta (n=47), aortic arch (n=30), and descending aorta (n=21). The mean lengths from STJ to innominate artery and STJ to ET were 79.5±11.4 mm and 57.8±52.1 mm, respectively. When we applied the IFU to each anatomical measurement, we identified 0 patients as candidates for Zenith Ascend, 9 (6.9%) for Zenith A-branch, and 60 (45.8%) for TAG TBE. Conclusions: Endovascular treatment for TAAD was not feasible for most of this study population, with risk of stent graft-induced new entry in 81.7% of patients, despite the use of next-generation stent grafts.