STABILISE; treatment of aortic dissection, a single Centre experience

Abstract

Purpose To outline the process of the STABILISE technique and its use; reporting patient outcomes and midterm follow up for complicated aortic dissection. Materials and methods Single centre retrospective analysis from January 2011 to January 2021 using the STABILISE technique which utilises balloon assistance to facilitate intimal disruption and promote aortic relamination. Results Sixteen patients underwent endovascular aortic repair with the STABILISE technique for aortic dissection over the study period. Fourteen patients (14/16; 88%) had acute dissection. Two of 16 (12%) were chronic. The median age of the patient cohort was 61 years (range 32–80 years) and consisted of a male majority (n = 11; 69%). The median time from diagnosis to intervention was 5 days (1–115 days; IQR 1–17.3). More than half (56%) had surgical repair of a acute type A aortic dissection prior to radiological intervention. The procedure was technically successful with no procedural mortality. Two patients were lost to follow up and two died in the post-operative period. Twelve patients had ongoing follow up with an average number of 2.9 ± 1.6 scans performed. Follow up was available in thirteen patients (81%) with a median follow up period of 1097 days (IQR 707–1657). The rate of re-intervention (n = 2/16; 13%) requiring additional stenting was in line with published re-intervention data (15%). Follow up showed a reduction in false lumen size following treatment with total luminal dimensions remaining stable over the follow-up period. Conclusion The STABILISE technique as a procedure for complicated aortic dissection, either acute or chronic, appears safe with stable mid-term aortic remodelling and patient outcomes. Level of evidence Level 3, Retrospective cohort study.

Endovascular Treatment of Type A Aortic Dissection: A Systematic Review and Meta-Analysis Using Reconstructed Time-to-Event Data

“…In this statement, endovascular treatment of TAAD was not formally endorsed due to scarcity of high-quality cumulative data [8]. The present systematic review addresses this gap in the literature and constitutes the most comprehensive synopsis of TAAD management with TEVAR to date [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]. Herein, mean patient age at the time of intervention was 60.7 years.…”

“…Data regarding the timing of TAAD were available in 16/20 studies [26][27][28]31,33,34,[36][37][38][39][40][41][42][43][44][45]. In total, 72.00% (95% CI, 52.45-88.64%) of our cohort suffered from acute TAAD (<14 days), 4.12% (95% CI, 0.00-19.19%) had subacute TAAD (15-90 days), while chronic dissection (>90 days) was present in 12.75% (95% CI, 2.24-47.09%) of the reported patients.…”

Idiopathic omental hemorrhage: a case report and review of the literature

“…Through our case analysis and literature review, it has been observed that the prevailing diagnostic model for arteriovenous malformation primarily relies on the presence of positive FAST, abdominal pain, imaging evidence of fluid accumulation, and a reduction in hemoglobin levels, all of which collectively indicate the likelihood of AVM occurrence. CT angiography (CTA) may have false negative results, however, due to short acquisition times when bleeding is not obvious at time of scan [ 20 ]. It has been described that transcatheter arterial embolization is a definitive treatment [ 21 ].…”

Changing Management of Type B Aortic Dissections

“…34 The device has not gained widespread use but established the feasibility of balloon membrane rupture to eliminate the false lumen, a technique that would be subsequently modified by others to achieve more complete treatment of TBAD using the STABILISE technique. [35][36][37][38][39][40][41][42][43][44][45][46][47]…”

“…58 Others have reported similar results in both the acute and chronic setting using the STABILISE teichnique. 35,37,39,43,59,60 Some have recommended more aggressive use of distal stenting and endografting in the infrarenal and iliac segments to cover all identifiable reentry tears. These reports suggest improved remodeling of the abdominal aortoiliac segment at the potential expense of increased SCI.…”