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Combined proximal endografting with distal bare-metal stenting for management of aortic dissection.
- Source :
-
The Annals of thoracic surgery [Ann Thorac Surg] 2012 Jan; Vol. 93 (1), pp. 95-102. Date of Electronic Publication: 2011 Nov 30. - Publication Year :
- 2012
-
Abstract
- Background: Established endovascular treatments for aortic dissection often result in incomplete aortic repair, potentially leading to late complications involving the distal aorta. To address the problems of incomplete true lumen reconstitution and late aneurysmal change, we report the midterm results of combined proximal endografting with distal true lumen bare-metal stenting (STABLE: Staged Total Aortic and Branch vesseL Endovascular reconstruction) in Stanford type A and B aortic dissection.<br />Methods: Between January 2003 and January 2010, 31 patients underwent staged total aortic and branch vessel endovascular reconstruction for management of acute (type A, 13; type B, 11) and chronic (type B, 7) aortic dissection. Proximal endografting was combined with bare-metal Z stent implantation in the distal true lumen. Patients with type A dissection underwent adjunctive treatment at operation. Computed tomography angiography was performed at baseline, 1 year, and annually thereafter to assess aortic remodelling.<br />Results: Primary technical success was 97%. Thirty-day rates of death, stroke, and permanent paraplegia/paresis were 3% (n=1), 0%, and 0%, respectively. Mean follow-up was 57.3 months (range, 5 to 100 months). Overall survival was 60% at 100 months. Aortic-specific survival was 93%. Four patients (13%) underwent device-related reintervention. One (3%) late aortic-related death occurred. Thoracic (p=0.64) and abdominal (p=0.14) aortic dimensions were stable. The true lumen index increased significantly at follow-up.<br />Conclusions: Staged total aortic and branch vessel endovascular reconstruction is a feasible ancillary endovascular technique to address the problems of distal true lumen collapse, incomplete aortic remodelling, and late aneurysm formation in aortic dissection.<br /> (Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aortic Dissection diagnostic imaging
Aortic Aneurysm, Thoracic diagnostic imaging
Aortography
Female
Follow-Up Studies
Humans
Male
Middle Aged
Prosthesis Design
Retrospective Studies
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Aortic Dissection surgery
Aortic Aneurysm, Thoracic surgery
Blood Vessel Prosthesis Implantation methods
Stents
Subjects
Details
- Language :
- English
- ISSN :
- 1552-6259
- Volume :
- 93
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- The Annals of thoracic surgery
- Publication Type :
- Academic Journal
- Accession number :
- 22133900
- Full Text :
- https://doi.org/10.1016/j.athoracsur.2011.06.106