Endovascular Stent-Graft Repair of Acute Thoracic Aortic Dissection - Early Clinical Experiences

Tiesenhausen, Kurt; Amann, W.; Koch, G.; Hausegger, K. A.; Oberwalder, Peter; Rigler, B

doi:10.1055/s-2001-9909

Cited by 38 publications

(16 citation statements)

References 9 publications

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“…Furthermore, the therapeutic strategies for type B aortic dissection have changed during previous years, particularly for malperfusion and the locally enlarged aorta, where new interventional methods with fenestration and endoaortic prostheses are promising. 15,16 This study, however, provides a direction for the continued discussion of managing patients with acute type B dissection.…”

Section: Figmentioning

confidence: 94%

Predictors of surgical indications for acute type B aortic dissection based on enlargement of aortic diameter during the chronic phase

Kunishige

Myojin

Ishibashi

et al. 2006

Jpn J Thorac Cardiovasc Surg

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These data suggest that patients with acute type B dissection with a patent false lumen or a diameter > or = 45 mm (or both) during the acute phase are at risk for enlargement of the dissecting aorta. The patients with dissecting aortas > or = 45 mm or a patent false lumen (or both) therefore require close follow-up to detect enlargement of the dissecting aorta, whereas patients with a maximum aortic diameter of < 45 mm with a thrombosed false lumen can stay on conservative therapy.

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Section: Figmentioning

confidence: 94%

Predictors of surgical indications for acute type B aortic dissection based on enlargement of aortic diameter during the chronic phase

Kunishige

Myojin

Ishibashi

et al. 2006

Jpn J Thorac Cardiovasc Surg

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“…61 Soon after the introduction of TEVAR, TBAD-related morbidity and mortality decreased dramatically. [61][62][63][64][65][66][67][68][69][70] The aim of TEVAR for aortic dissection is to discontinue blood flow into the false lumen by covering the primary entry tear, and to restore blood flow into the true lumen. The false lumen subsequently depressurizes, preventing extension of dissection and ideally leading to false lumen thrombosis with subsequent aortic remodeling.…”

Section: Endovascular Procedures Tevar (Thoracic Endovascular Aortic mentioning

confidence: 99%

Update in the management of type B aortic dissection

et al. 2016

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Stanford type B aortic dissection (TBAD) is a life-threatening aortic disease. The initial management goal is to prevent aortic rupture, propagation of the dissection, and symptoms by reducing the heart rate and blood pressure. Uncomplicated TBAD patients require prompt medical management to prevent aortic dilatation or rupture during subsequent follow-up. Complicated TBAD patients require immediate invasive management to prevent death or injury caused by rupture or malperfusion. Recent developments in diagnosis and management have reduced mortality related to TBAD considerably. In particular, the introduction of thoracic stent-grafts has shifted the management from surgical to endovascular repair, contributing to a fourfold increase in early survival in complicated TBAD. Furthermore, endovascular repair is now considered in some uncomplicated TBAD patients in addition to optimal medical therapy. For more challenging aortic dissection patients with involvement of the aortic arch, hybrid approaches, combining open and endovascular repair, have had promising results. Regardless of the chosen management strategy, strict antihypertensive control should be administered to all TBAD patients in addition to close imaging surveillance. Future developments in stent-graft design, medical therapy, surgical and hybrid techniques, imaging, and genetic screening may improve the outcomes of TBAD patients even further. We present a comprehensive review of the recommended management strategy based on current evidence in the literature.

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“…Aneurysms and dissections of the descending thoracic aorta are still a challenge in medicine, and so several centers around the world have studied and published their results of this therapeutic option represented by the use of stentgrafts introduced by the femoral artery [8,[13][14][15][16][17][18][19][20].…”

Section: Commentsmentioning

confidence: 99%

Experience with utilization of auto-expandable stents introduced through the femoral artery for treatment of thoracic aortic diseases

Breda¹,

Almeida²,

Filho³

et al. 2003

Rev Bras Cir Cardiovasc

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Introduction:The authors describe their experience with the implantation of endovascular self-expanding stent-grafts for the treatment of descending aortic thoracic diseases.Method: From June 1996 to April 2002, 14 endovascular self-expanding stent-grafts were implanted, 10 in acute type B dissections, 3 in atherosclerotic aneurysms and 1 in a penetrating aortic ulcer. The patient's ages varied between 43 and 77 years (mean = 63.3 years). In the majority of cases the procedure was performed under general anesthesia. The delivery of the stent-graft endoprostheses was performed using the trans-femoral system.Results: There was one death on the sixth postoperative day by pulmonary thromboembolism. One patient was operated on for the implantation of an endovascular selfexpanding stent-graft through the aortic arch under deep hypothermia and circulatory arrest, and died eight months after operation. All the survivors were well and imaging studies showed adequate correction of the aortic disease.Conclusion: Preliminary results suggest that this technique will contribute to improve surgical results in the treatment of descending thoracic aortic diseases. Resultados: Houve um óbito, no sexto dia de pós-operatório, por tromboembolismo pulmonar. Um paciente foi encaminhado para tratamento cirúrgico eletivo, tendo sobrevivido por 8 meses. Os sobreviventes estão bem clinicamente e com estudo por imagem mostrando correção da doença.Conclusão: Resultados preliminares sugerem que esta técnica representa uma alternativa para tratamento das doenças da aorta torácica descendente.

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Endovascular Stent-Graft Repair of Acute Thoracic Aortic Dissection - Early Clinical Experiences

Abstract: Endoluminal treatment of acute thoracic aortic dissection seems to be a less invasive and effective therapy. Long-term results for this method are necessary.

Cited by 38 publications

References 9 publications

Predictors of surgical indications for acute type B aortic dissection based on enlargement of aortic diameter during the chronic phase

Predictors of surgical indications for acute type B aortic dissection based on enlargement of aortic diameter during the chronic phase

Update in the management of type B aortic dissection

Experience with utilization of auto-expandable stents introduced through the femoral artery for treatment of thoracic aortic diseases

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