Endovascular repair of complicated acute type-B aortic dissection with stentgraft: early and mid-term results

Abstract

Objectives: To analyse the experience of a single centre and evaluate the early and mid-term results of endovascular repair of complicated acute type B aortic dissection with stentgrafts.

Method: From July 2002 to January 2009, 45 patients (12 women, 33 men) with complicated acute type B aortic dissection (mean age, 42.6 years; range, 31-47 years) were treated with Thoracic Endovascular Aortic Repair (TEVAR). Indications for treatment included rupture in 6(13%), hemathorax with impending rupture in 27(60%), malperfusion syndrome in 11 (22%), and transient paraplegia in one patient (2.2%). Five kinds of commercially available thoracic stentgrafts were used. Follow up was 100% during a period of 13 months (range, 1-36 months).

Results: Technical success (coverage of the primary tear site) was achieved in all 45 patients(100%) including deliberate partial or total coverage of the LSA in 7 patients (15.6%). The 30-day and in-hospital mortality was 4.4% including one late rupture case. Overall survival was 95.6% at 1 and 3-years' follow-up. None of the patients with malperfusion required adjunct distal stents All hemothoces resolved within 3 months including 5 patient required thoracentesis and one had tube thoracostomy. And 7 patients required temporary dialysis In-hospital complications occurred in 26.7% of patients and re-intervention was required in one patient and no patient had postoperative paraplegia Postoperative CT angiography showed 25 patients (58.1%) with complete thrombosis of the false lumen and re-expansion of the true lumen.

Conclusions: Endovascular repair of complicated acute type B aortic dissection with stentgraft is proven to be a technically feasible and effective in this relatively difficult patient cohort, The short and mid-term efficacy are persuasive, however, the long-term efficacy needs to be evaluated further.