Percutaneous interventions for treating ischemic complications of aortic dissection

Abstract

The aim of this study was to evaluate the role of percutaneous interventions in treating ischemia complicating aortic dissection. Forty-five patients with ischemia complicating aortic dissection were treated by balloon fenestration, true lumen stenting, angioplasty, or thrombolysis. Clinical and laboratory examinations were performed before and after intervention, and at the end of follow-up (median 37 months). Eighteen dissections were acute, 9 sub-acute, and 18 chronic. Mesenterohepatic ischemia resolved in 16 of 18 patients; lactate and SGOT values fell from 2.89 to 1.23 mmol/L (p=0.006) and from 165.9 to 59.7 U/L (p=0.034), respectively. In patients with renal ischemia, creatinine levels fell from 360.1 to 196.3 micromol/L (p=0.007) accompanied by a significant reduction in blood pressure. Limb-threatening ischemia resolved in three of four patients; in 21 claudicants, the mean walking distance improved from 272 to 1,283 m (p=0.001). Spinal ischemia resolved completely or partially in six of eight patients. Adjunctive surgical measures were necessary in six patients. Overall 30-day mortality in the 45 patients was 6.7%; all three deaths were in patients with acute dissections (mortality in this subgroup 16.7%). Ischemia complicating aortic dissection can be effectively treated by percutaneous interventions resulting in good early and mid-term outcomes.

Aortic Dissection: Accurate Subintimal Flap Fenestration by Using a Reentry Catheter with Fluoroscopic Guidance—Initial Single-Institution Experience

“…The fluoroscopically guided approach proposed in our study can be performed without the need of intravascular US guidance or target placing (6,10,11,25,26,27). In our study, navigation difficulties under fluoroscopic guidance did not occur.…”

“…In such a scenario, additional endovascular therapy such as percutaneous fenestration may be valuable, as we documented in two patients in our small study. Furthermore, stentgraft placement may not be adequate if organs are perfused from the false aortic lumen (26). In this setting, uncertainties may exist as to whether the sealing of the proximal entry site could lead to thrombosis and organ infarction in many of the treated patients (3).…”

“…After percutaneous fenestration, secondary bare metal stent implantation also may become necessary in patients with unstable dissection flaps or with persisting malperfusion of aortic side branches after percutaneous fenestration (26,28). Primary bare metal stent implantation is a treatment option in cases of static configurations with a dissection passing through a branch vessel and compromising it (25).…”

Endovascular management of type B aortic dissections

“…20 Thirteen patients had type A dissections, and 32 had type B. The study included both acute and chronic dissections.…”

Uncovered stent implantation in complicated acute aortic dissection type B

“…This has been combined with insertion of uncovered stents into compromised aortic branches. [1][2][3][4][5] In the past 10 years, the insertion of covered stents into the aortic true lumen (aTL) of the proximal descending aorta has become increasingly popular to seal the entry into the false lumen (FL). [6][7][8][9][10][11][12] This concept has its limitations, for example, in the presence of several entries, which is not uncommon.…”