Endovascular stent-graft treatment of thoracic aortic dissection

Yang, Jian; Zuo, Junli; Yang, Lifang; Duan, Weixun; Xiong, Li; Zheng, Ming‐Hua; Cui, Huili

doi:10.1510/icvts.2006.135442

Cited by 16 publications

(10 citation statements)

References 10 publications

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“…Recent data on endovascular repair of chronic complicated TBAD reveal excellent procedural and survival outcomes, but at the expense of further re-interventions. The rates of stroke following endovascular-based repair ranged between 0% to 5%, it was 0% to 2% for paraplegia, up to 14% procedure-related mortality (20)(21)(22)(23)(24)(25)58,60,(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74) (Table 7).…”

Section: Medical Managementmentioning

confidence: 99%

Conservative management versus endovascular or open surgery in the spectrum of type B aortic dissection

Yuan¹,

Mitsis²,

Ghonem³

et al. 2018

J. Vis. Surg.

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Background: Type B aortic dissection is a life-threatening acute aortic condition often with acute ischemic signs or symptoms. With initial management focusing on alleviating malperfusion and pain, and avoiding propagation of dissection or rupture both systolic blood and pulse pressure should be reduced initially by an aggressive medical approach. In the setting of persistent signs of complications endovascular strategies have replaced open surgery and led to a fourfold increase in early survival and better long-term outcomes. Results: Our manuscript has summarized data collected over 12 years on management specific outcomes in the setting of distal aortic dissection and provides an up-to-date interpretation of the published evidence.For complicated cases, treated acutely, the 30-day or in-hospital mortality was 7.3% when managed by endovascular means, whereas the pooled rate for 30-day or in-hospital mortality was 19.0% when subjected to open repair. For acute uncomplicated type B dissection usually treated with blood pressure lowering medications, the pooled 30-day or in-hospital mortality rate was 2.4%. Survival rates at 5 years averaged at 60% (40% mortality). Freedom from any aortic event ranged from 34.0% to 83.9%, underlining an inherent risk of progression and late complications. For chronic complicated type B dissection, the rates of stroke, paraplegia and operative mortality following endovascular repair ranged from 5% to 13%, 2% to 13% and 2 to 13%, respectively, while 5-year survival rates after open repair ranged from 60% to 90%. In chronic uncomplicated type B dissection almost 90% of patients survive initial hospitalization and were subjected to medical management with a 5-year survival of 50-80%. However, up to 20-55% of medically treated patients develop aneurysmal degeneration after 5 years with an unknown risk of rupture.Conclusions: Currently, the less invasive strategy of endovascular repair (as compared to open surgery) provides improved 30-day or in-hospital survival in the setting of complicated acute type B aortic dissection and may seek broad application. Open surgical aortic reconstruction should be left to experienced aortic centres if endovascular management is not an option.

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Section: Medical Managementmentioning

confidence: 99%

Conservative management versus endovascular or open surgery in the spectrum of type B aortic dissection

Yuan¹,

Mitsis²,

Ghonem³

et al. 2018

J. Vis. Surg.

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“…A chamada técnica do varal é classicamente descrita para a correção endovascular de aneurisma de aorta abdominal e torácica 2,6,7 . Conseguimos transportar a experiência adquirida com o uso desta técnica para solucionar o problema encontrado durante uma angioplastia de veia central.…”

Section: Discussionunclassified

“…Nessas condições, algumas técnicas mostram-se úteis, como é o caso da do varal 6,7 . A técnica do varal utilizada para correção de aneurisma de aorta consiste na passagem de um fio-guia da artéria femoral até a braquial e posterior tração das suas extremidades, com retificação por um mecanismo de estiramento.…”

Section: Introductionunclassified

Utilização da técnica do varal para angioplastia de estenose de veia central com stent-graft

Moreira

Carrilho²,

Oliveira

et al. 2012

J. vasc. bras.

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IntroduçãoA estenose ou oclusão de veia central é um problema comum nos pacientes com insuficiência renal crônica e geralmente está relacionada ao uso prévio de cateteres 1 . A incidência do problema tem sido relatada na literatura como presente em 25 a 40% dos pacientes em hemodiálise 2 . Essas lesões comumente são muito rígidas e de difícil recanalização quando ocluídas, de forma que quando se tornam sintomáticas podem levar a edema do membro homolateral ao acesso arteriovenoso ou edema da face 1 . Opções terapêuticas disponíveis são: ligadura da fístula arteriovenosa, intervenção cirúrgica com criação de uma ponte veno-venosa ou abordagem endovascular com angioplastia transluminal percutânea da lesão estenótica com ou sem a colocação de stent 1 . Apesar de não existirem estudos na literatura que indiquem a superioridade do stent em relação à angioplastia com balão, há claramente um grupo de pacientes que não é responsivo somente a este tipo de angioplastia, necessitando ResumoA estenose de veia central é uma das situações mais frequentes em pacientes com insuficiência renal crônica em hemodiálise. A angioplastia com o uso de stent-graft tem obtido bons resultados nestes casos. O sistema de liberação dos stents é de calibre maior, podendo dificultar sua navegabilidade em áreas de estenose ou tortuosidade acentuadas. A técnica do varal é comumente utilizada para o tratamento endovascular do aneurisma de aorta, permitindo atingir bom mecanismo de estiramento e facilitando a navegação do sistema de entrega da endoprótese. Descrevemos o caso de uma angioplastia de veia central com stent-graft na qual foi utilizada a técnica do varal para permitir a transposição da área de estenose.Palavras-chave: derivação arteriovenosa cirúrgica; angioplastia; diálise renal. AbstractThe central vein stenosis is one of the most common conditions in patients with chronic kidney failure in a hemodialysis program. In these cases, angioplasty using stent-grafts has obtained good results. The stent-graft delivery system is generally of large diameter what can hinder its navigability in very severe stenosis or tortuosities. The through-and-through technique is commonly used for endovascular treatment of aortic aneurysms, making possible to achieve a good mechanism of stretch and easy navigation of the endograft delivery system. We report a case of a central venous stenosis in wich a stent-graft was inserted using the through-and-through technique in order to cross the lesion.

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“…For type B aortic dissection, regardless of the time of onset, entry closure by TEVAR has shown favorable early results, 16,17 but with cases of intimal damage due to stent grafts and retrograde type A aortic dissections revealed by later follow-up. 18,19 Furthermore, despite thrombosis of a false lumen in the thoracic region by TEVAR, the false lumen distal to the stent graft may fail to thrombose and can thus expand.…”

Section: Discussionmentioning

confidence: 99%

Hybrid procedures combining conventional and thoracic endovascular aortic repair for thoracic aortic aneurysms

et al. 2011

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Endovascular stent-graft treatment of thoracic aortic dissection

Cited by 16 publications

References 10 publications

Conservative management versus endovascular or open surgery in the spectrum of type B aortic dissection

Conservative management versus endovascular or open surgery in the spectrum of type B aortic dissection

Utilização da técnica do varal para angioplastia de estenose de veia central com stent-graft

Hybrid procedures combining conventional and thoracic endovascular aortic repair for thoracic aortic aneurysms

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