Endovascular treatment for dissection of the descending aorta

Beregi, Jean‐Paul; Prat, Alain; Gaxotte, Virginia; Delomez, M; McFadden, Eugène

doi:10.1016/s0140-6736(00)02560-5

Cited by 104 publications

(57 citation statements)

References 3 publications

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“…1,2 Goals of stent-graft placement are to reestablish arterial flow to ischemic beds and to abolish pulsatile antegrade perfusion of the false lumen, which should reduce subsequent false lumen enlargement and rupture. [3][4][5][6][7][8] Continued pressurization and perfusion of the false lumen due to endoleak, however, is frequently seen after stent-graft repair of aortic dissection. 9,10 Compared with endoleaks encountered after thoracic endovascular aneurysm repair, endoleak physiology in aortic dissection is complex and incompletely understood.…”

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confidence: 99%

Factors Portending Endoleak Formation After Thoracic Aortic Stent-Graft Repair of Complicated Aortic Dissection

Sze

Bosch

Dake

et al. 2009

Circ: Cardiovascular Interventions

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Background-Endoleaks after stent-graft repair of aortic dissections are poorly understood but seem substantially different from those seen after aneurysm repair. We studied anatomic and clinical factors associated with endoleaks in patients who underwent stent-graft repair of complicated type B aortic dissections. Methods and Results-From 2000 to 2007, 37 patients underwent stent-graft repair of acute (Յ14 days; nϭ23), subacute (15 to 90 days; nϭ10) or chronic (Ͼ90 days; nϭ4) complicated type B aortic dissections using the Gore Thoracic Excluder (nϭ17) or TAG stent-grafts (nϭ20) under an investigator-sponsored protocol. Endoleaks were classified as imperfect proximal seal, flow through fenestrations or branches, or complex (both). Variables studied included coverage of the left subclavian artery, aortic curvature, completeness of proximal apposition, dissection chronicity, and device used. Endoleaks were found during follow-up (mean, 22 months) in 59% of patients, and they were associated with coverage of the left subclavian artery (complex, PϽ0.001), small radius of curvature (type 1 and complex, Pϭ0.05), and greatest length of unapposed proximal stent graft (complex, PϽ0.0001). During follow-up, 10 endoleaks resolved spontaneously, 6 required reintervention for false lumen dilatation, and 2 were stable without clinical consequences. Conclusions-Endoleaks are common after stent-graft repair of aortic dissection and may lead to false lumen enlargement necessitating reintervention. Anatomic complexities such as acute aortic curvature and covered side branches were associated with endoleaks, illustrating the need for dissection-specific device development.

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confidence: 99%

Factors Portending Endoleak Formation After Thoracic Aortic Stent-Graft Repair of Complicated Aortic Dissection

Sze

Bosch

Dake

et al. 2009

Circ: Cardiovascular Interventions

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“…Beregi, et al reported a promising effect when using endovascular treatment (fenestration and stent) for patients with ischemic complications of descending aortic dissections. 29) One recent study reported that 19 patients with descending thoracic AAD successfully underwent endovascular stent-graft deployment without complications. 30) Use of an EVS device minimizes invasiveness and blood loss, operative time, length of hospital stay, and complications, while increasing patient satisfaction.…”

Section: Discussionmentioning

confidence: 99%

<b>Newly Diagnosed Acute Aortic Dissection</b>

et al. 2005

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SUMMARYThe objective of the present study was to examine cases of acute aortic dissection in order to analyze the clinical and diagnostic findings, and to summarize their treatment modalities, as well as their hospital outcomes.Between July 1998 and June 1999, we prospectively studied patients who were newly diagnosed as having acute aortic dissection at 25 hospitals in Mie prefecture. These cases were examined for their demographics, the characteristics of the clinical findings, diagnostic methods, treatment modalities according to the type of aortic dissection, and the early morbidity and mortality of the hospital outcomes.Of 66 newly diagnosed aortic dissections (43 males), 30 were type A and 36 were type B. Seventy-six percent of the cases arrived at a medical facility within 6 hours from the onset of symptoms. Frequent initial symptoms and clinical findings were pain in 95.5%, cardiac arrest and/or hypotension in 21%, pericardial effusion in 29%, pleural effusion in 25%, and neurological signs in 30%. Twenty-one patients underwent surgical repair, 36 were treated medically, and 5 underwent endovascular stenting. Overall early mortality was 12.1%, which included 2 DOA. Fifty percent of these deaths occurred within 48 hours, and 63% by 72 hours of the initial event.In spite of the relatively rare incidence of acute aortic dissection in our study, the calculated incidence was 4.0/100,000/year. The overall mortality rate was relatively low compared to the figures reported in the literature, suggesting the earliest possible diagnosis and timely intervention are critically important to attain successful outcomes. (Int Heart J 2005; 46: 1083-1098

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“…In cases with evidence of impending rupture or end-organ ischemia endovascular management was favoured. Ranging from aortic fenestration (scissor technique) to aortic stent graft implantation and/or visceral (renal, celiac, superior mesenteric arteries) stenting [6][7]. Malperfusion syndrome presented as bowel, renal and/or lower limb clinical acute ischemia.…”

Section: Methodsmentioning

confidence: 99%