Endovascular Treatment of Aortic Type B Dissection and Penetrating Ulcer  Using Commercially Available Stent-Grafts

Sailer, Johannes; Peloschek, Philipp; Rand, Thomas; Grabenwöger, Martin; Thurnher, Siegfried; Lämmer, Johannes

doi:10.2214/ajr.177.6.1771365

Cited by 42 publications

(33 citation statements)

References 12 publications

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“…In our experience with 15 patients, we have observed one retrograde ascending aortic dissection following stent grafting. Post-operative access site bleeding necessitating surgical evacuation was observed in 1 of 7 patients reported by Sailer et al also [27]. A minor stroke in 1 of 10 patients has been reported by Kato et al [31].…”

Section: Stent Graft Implantationmentioning

confidence: 82%

“…The various diagnostic modalities used for this purpose include CT angiography (CTA), magnetic resonance imaging (MRI), colour Doppler trans-oesophageal echocardiography (TEE) as well as digital subtraction angiography (DSA). Whereas Nienaber et al used MRI for this purpose [4], most other authors use CTA as the pre-operative diagnostic modality [3,27,28,29]. Should the precise localization of the entry tear not be possible by these means, DSA in combination with TEE during the procedure generally reveals the site of entry.…”

Section: Localization Of Proximal Entry Tearmentioning

confidence: 99%

“…If the diameter of the chosen endograft is too large as compared with the diameter of the non-dissected proximal aortic segment, the endograft may be extruded out of this segment and dislocate distally during or after release. The mean length of the endografts used by Dake Results: stent grafts for proximal entry closure Stent-graft deployment is generally possible in all cases with successful entry closure in 86-100% of the patients [3,4,27,28,29,30,31]. Both Nienaber [4] and Hausegger [30] have treated dissections with entries 5 mm or more away from the origin of the left subclavian artery.…”

Section: Stent Graft Implantationmentioning

confidence: 99%

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Endoluminal treatment of aortic dissection

et al. 2003

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Aortic dissection is most often a catastrophic medical emergency which, if untreated, can be potentially fatal. The intention of therapy in patients with aortic dissection is to prevent aortic rupture or aneurysm formation as well as to relieve branch vessel ischaemia. Patients with aortic dissection are often poor candidates for anaesthesia and surgery and the surgical procedure itself is challenging requiring thoracotomy, aortic cross clamping, blood transfusion as well as prolonged hospital stay in some cases. Operative mortality is especially high in patients with critical mesenteric or renal ischaemia. The past decade has experienced the emergence of a number of interventional radiological or minimally invasive techniques which have significantly improved the management of patients with aortic dissection. These include stent grafting for entry site closure to prevent aneurysmatic widening of the false lumen as well as percutaneous techniques such as balloon fenestration of the intimal flap and aortic true lumen stenting to alleviate branch vessel ischaemia. False lumen thrombosis following entry closure with stent grafts has been observed in 86-100% of patients, whereas percutaneous interventions are able to effectively relieve organ ischaemia in approximately 90% of the cases. In the years to come, it is to be expected that these endoluminal techniques will become the method of choice for treating most type-B dissections and will assist in significantly reducing the number of open surgical procedures required for type-A dissections. The intention of this article is to provide an overview of the current status of these endoluminal techniques based on our own experience as well as on a review of the relevant literature.

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Section: Stent Graft Implantationmentioning

confidence: 82%

Section: Localization Of Proximal Entry Tearmentioning

confidence: 99%

Section: Stent Graft Implantationmentioning

confidence: 99%

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Endoluminal treatment of aortic dissection

et al. 2003

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“…Stent-Graft-Implantate zeigen bei der Therapie penetrierter Ulzera in klinischen Studien viel versprechende Langzeitergebnisse [23,25]. Aufgrund des erhöhten Operationsrisikos bei typischerweise hohem, meist mit Multimorbidität und Aortenkalzifikation assoziiertem Alter der Patienten stellen sie eine mög-liche Alternative zur Thorakotomie dar.…”

Section: Differential Diagnosis Of Saccular Aneurysms Of the Isthmus unclassified

Sakkiforme Aneurysmen des Isthmus aortae

Müller

Hoffmann

Weber

et al. 2004

Chirurg

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Most aneurysms of the isthmus aortae, particularly those following thoracic trauma, are most likely to be diagnosed as acute dissecting or post-traumatic pseudoaneurysms. Furthermore, penetrating atherosclerotic ulcers in patients with atherosclerosis, congenital aneurysms such as ductus diverticulum and Kommerell's diverticulum, luetic aneurysms, and saccular aneurysms associated with Marfan's syndrome have to be included in the list of differential diagnoses. In view of the severe effect of any open thoracic surgical intervention, exact preoperative diagnosis is crucial. We report the case of a 73-year-old male patient who was accidentally diagnosed with an aneurysm of the atherosclerotic isthmus aortae. The aneurysm extended from the aorta to the dorsal site. The sacciform aneurysm (4.5 cm) was resected electively. Based upon localisation and pathomorphological findings, a penetrating ulcer was diagnosed. We also present a review of the current literature and give a survey of the differential diagnoses of aneurysms of the aortic isthmus: penetrating atherosclerotic ulcus, acute (traumatic) dissecting aneurysm, post-traumatic pseudoaneurysm, ductus diverticulum, Kommerell's diverticulum, syphilitic aneurysm, and sacciform aneurysm due to Marfan's syndrome.

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“…In interventional therapy, the primary aim is occlusion of the entry tear with subsequent decompression, collapse, and thrombosis of the false lumen and true lumen expansion [53,54,55,56,57,58,59,60,61]. This can be achieved by transfemoral insertion of a tubular stentgraft.…”

Section: Therapymentioning

confidence: 99%

Traumatic injuries: imaging and intervention of large arterial trauma

Schoder¹,

Prokop

Lämmer³

2002

Eur Radiol

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Traumatic vessel injury can cause bleeding, thrombosis, embolization, or malperfusion due to external compression and spasm. Non-traumatic causes of acute large arterial emergencies include rupture of an aneurysm and pseudoaneurysm, dissection, embolization, and thrombosis in hypercoagulability syndromes. Ultrasonography is, of course, the imaging modality of choice in emergency cases; however, in central vascular injuries, spiral CT with contrast enhancement is the imaging modality that provides the most information. Angiography may be necessary for detailed information and before intervention. Stent-grafts are used to close large vascular lacerations, ruptured aortic aneurysms, and the entry tear of dissections. Interventional radiology methods play a major role in managing vascular emergencies.

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Endovascular Treatment of Aortic Type B Dissection and Penetrating Ulcer Using Commercially Available Stent-Grafts

Cited by 42 publications

References 12 publications

Endoluminal treatment of aortic dissection

Endoluminal treatment of aortic dissection

Sakkiforme Aneurysmen des Isthmus aortae

Traumatic injuries: imaging and intervention of large arterial trauma

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