Acute type I aortic dissection: Traditional versus hybrid repair with antegrade stent delivery to the descending thoracic aorta

Abstract

Antegrade endovascular grafting of the descending thoracic aorta during repair of acute type I aortic dissection is technically safe, does not increase the circulatory arrest time, and could help patients with preoperative malperfusion. Long-term follow-up data are needed.

Differential aspects of ascending thoracic aortic dissection and its treatment: the North American experience

“…Because of recent advances in TEVAR and evidence that it results in aortic remodeling and future falselumen thrombosis in patients with aortic dissection in the descending thoracic aorta (36), certain aortic surgery centers have advocated antegrade or retrograde stent delivery in the descending thoracic aorta with simultaneous hemiarch or arch surgery for acute type I aortic dissection (29,31,37). This approach is thought to promote remodeling of the distal aorta and prevent chronic dissecting aneurysm formation that would necessitate additional distal aortic intervention.…”

“…This approach is thought to promote remodeling of the distal aorta and prevent chronic dissecting aneurysm formation that would necessitate additional distal aortic intervention. Reportedly, the additional stent delivery during the procedure is safe, resolves possible malperfusion, and promotes aortic remodeling (29,31,37). Spinal cord ischemia remains a concern with simultaneous antegrade or retrograde stent delivery; thus, stent length is usually 15 cm or less.…”

“…A balloon-tip catheter is used for ACP in the left common carotid artery after the aorta is divided (17 (37). Instead, we prefer to perform antegrade stent graft delivery in the descending thoracic aorta (acute type I aortic dissection) over a stiff wire as previously described (37) and then to reconstruct the distal aortic anastomosis. After stent graft deployment, the distal anastomosis is constructed by leaving only a small, V-shaped piece of native aortic tissue at the arch.…”

The skeleton elephant trunk: A technique looking for an indication

“…Previously, uncovered stents have been used to treat complicated type B aortic dissection in an effort to improve true-lumen perfusion and diameter; however, this technique failed to suppress false-lumen patency completely and to prevent stent fractures and migration necessitating reintervention. 2,3 No solid data thus currently exist regarding the benefit of uncovered stents for treating complicated type B aortic dissection. Hybrid techniques for treating acute DeBakey type I aortic dissection have been introduced in an effort to increase aortic event-free survival and to decrease reinterventions without increasing short-term mortality or morbidity.…”

Management of the aortic arch and descending thoracic aorta for acute type A dissection: Moving away from the “less is more” paradigm

“…4,5 This technique maintains the relative simplicity of the transverse hemiarch procedure relative to total arch replacement while also providing the benefit of treating proximal DTA tear and providing DTA stabilization for improved distal aortic remodeling. This technique is not applicable, however, in cases of unresectable aortic arch or arch vessel primary tears.…”