Endovascular Stent-Graft Repair of Acute Thoracic Aortic Dissection - Early Clinical Experiences

Background: Standard treatment of acute thoracic aortic dissection type B is the medical therapy used for most patients, according to Stanford. Surgical therapy involves a high mortality rate and is reserved for patients with complicated dissections. We report from four patients with acute thoracic aortic dissection, treated endoluminally by stent-graft implantation. Methods: Four patients with complicated acute thoracic aortic dissections type B were treated endoluminally by transfemoral stent-graft implantation. Preoperative evaluation was performed with spiral-computed tomography and calibrated aortography. The Talent stent-graft system (Metronic) was used in all patients. Results: The primary entry tear could be sealed successfully and complete thrombosis of the false thoracic aortic lumen was obtained in all cases. In one patient, transposition of the left subclavian artery was performed, in two patients the stent-grafts had to be placed across the origin of the left subclavian artery. No severe intra- or postoperative complications occurred. Conclusion: Endoluminal treatment of acute thoracic aortic dissection seems to be a less invasive and effective therapy. Long-term results for this method are necessary.

Key words:

Acute thoracic aortic dissection - Therapy - Stent graft

References

• 1 Von Segesser L K, Burki H, Schneider K, Siebenmann R, Schmid E R, Turina M. Surgery of aneurysm of the descending thoracic aorta and paraplegia.  Helv Chir Acta. 1988;  55 503-508
• 2 Coselli J S, Plestis K A, La-Francesca S, Cohen S. Results of contemporary surgical treatment of descending thoracic aortic aneurysms: experience in 198 patients.  Ann Vasc Surg. 1996;  10(2) 131-137
• 3 Svensson L G, Hess K R, Coselli J S, Safi H J. Influence of segmental arteries, extent, and atriofemoral bypass on postoperative paraplegia after thoracoabdominal aortic operations.  J Vasc Surg. 1994;  20 255-262
• 4 Zanetti P M, Rosa G, Sorisio V. et al . Surgery of the descending thoracic and thoraco-abdominal arteries. Report of 105 cases.  G Ital Cardiol. 1997;  27(7) 682-685
• 5 Dake M D, Miller D C, Semba C P, Mitchell R S, Walker P J, Liddel R P. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysm.  N Engl J Med. 1994;  331 1729-1734
• 6 Dake M D, Kato N, Mitchell R S. et al . Endovascular stent-graft placement for the treatment of acute aortic dissection.  N Engl J Med. 1999;  340 1546-1552
• 7 Kato M, Matsuda T, Kaneko M. et al . Outcomes of stent-graft treatment of false lumen in aortic dissection.  Circulation. 1998;  98 (19 Suppl) II305-II312
• 8 Moon M R, Dake M D, Pelc L R. et al . Intravascular stenting of acute experimental type B dissections.  J Surg Res. 1993;  54 381-388
• 9 Nienaber C A, Fattori R, Lund G. et al . Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement.  N Engl J Med. 1999;  340 1539-1545
• 10 Pitt M P, Bonser R S. The natural history of thoracic aortic aneurysm disease: an overview.  J Card Surg. 1997;  12(2 Suppl) 270-278
• 11 Pressler V, McNamara J J. Thoracic aortic aneurysm: natural history and treatment.  J Thorac Cardiovasc Surg. 1980;  79 489-498
• 12 Slonim S M, Nyman U R O, Semba C P, Miller D C, Mitchell R S, Dake M D. Aortic dissection: percutaneous management of ischemic complications with endovascular stents and balloon fenestration.  J Vasc Surg. 1996;  23 241-251
• 13 Lachat M, Pfammatter T, Turina M. Transfemoral endografting of thoracic aortic aneurysm under local anesthesia: a simple, safe and fast track procedure.  Vasa. 1999;  28 204-206
• 14 Branchereau A, Magnan P E, Espinoza H, Bartoli J M. Subclavian artery stenosis: Hemodynamic aspects and surgical outcome.  J Cardiovasc Surg. 1991;  32 604-612
• 15 Ehrlich M, Grabenwöger M, Cartes Zumelzu F. et al . Endovascular stent graft repair for aneurysms on the descending thoracic aorta.  Ann Thorac Surg. 1998;  66(1) 19-25
• 16 Hughes J D, Bacha E A, Dodson T F, Martin T, Smith R B, Chaikof E L. Peripheral vascular complications of aortic dissection.  Am J Surg. 1995;  170 209-212
• 17 Mitchell R S, Dake M D, Sembra C P. et al . Endovascular stent-graft repair of thoracic aortic aneurysms.  J Thorac Cardiovasc Surg. 1996;  111 1054-1062
• 18 Seo Y, Kaneko M, Kuratani T, Mizushima T. Transcatheter stent-graft implantation for the treatment of acute aortic dissection-rupture of aneurysm because of perigraft leakage.  Nippon Kyobu Geka Gakkai Zasshi. 1998;  46(2) 179-184