Open stent grafting for complex diseases of the thoracic aorta: clinical utility

Abstract

Open stent grafting is an alternative treatment for extensive thoracic aortic replacement. However, this procedure is associated with a high incidence of spinal cord injury, which has limited its application. Multiple factors have been suggested to explain the risk of spinal cord injury, including deep delivery of the stent graft, history of operation of the downstream aorta, and postoperative low blood pressure. Cerebrospinal fluid drainage or a hybrid operation in combination with trans-femoral thoracic stent grafting is useful for preventing spinal cord injury. Open stent grafting remains an alternative treatment for atherosclerotic aneurysms with dilatation of the ascending aorta. Open stent grafting for acute aortic dissection is effective for remodeling of the false lumen. The graft diameter for aortic dissection should be 90 % of the total diameter of the aorta, and the distal landing zone should be limited to the T7 vertebral level to prevent new intimal tears or spinal cord injury. Open stent grafting seems a feasible bailout strategy for the treatment of retrograde aortic dissection after TEVAR for type B aortic dissection. Newly designed devices for open stent grafts include the Matsui-Kitamura stent graft or branched open stent graft, which is produced in Japan. The effectiveness of open stent grafting in the treatment of Marfan syndrome remains unclear. A commercially available device for open stent grafting would be desired in Japan. In conclusion, an open stent graft remains an alternative treatment for complex thoracic aortic pathologies.

Two Cases of Endovascular Repair with the Stent Graft for Retrograde Type A Acute Aortic Dissection with Complications

“…Recently, the effectiveness of open stent graft (OSG) for type A aortic dissection with proximal arch replacement has been reported. Uchida 4) reported that total arch replacement with OSG improved operative mortality and morbidity for RTAAD. However, resection of primary intimal tear may not always be possible even with use of OSG.…”

A Case of Traumatic Retrograde Type A Aortic Dissection Accompanied by Multiorgan Injuries

“…The development and prevalent use of open stent grafting has enabled not only the repair of intimal tears of the proximal descending aorta in patients with RAAD but also the exclusion of all antegrade blood flow in the false lumen, which could otherwise cause malperfusion syndrome or dilatation of the descending aorta in the long term. 6 ) Therefore, we performed open stent grafting in our patient to facilitate IVR therapy by expanding the true lumen and to prevent dilation of the descending aorta.…”

Long-Term Results of Open Stent-Grafting Using a Matsui-Kitamura Stent to Treat Thoracic Aortic Aneurysm

“…6,7) Early and long-term results of OSG in patients treated for aortic dissection have been described in some recent reports. 11,13,14) According to Uchida, et al, 11) the incidence of patent false lumen on the proximal descending aorta after hybrid OSG is less than 7% and the distal reoperation rate is under 6% when endovascular reintervention is performed. Our series had six cases of type A and six of type B aortic dissection.…”