Treatment of Thoracic Aortic Dissection with Stent-Grafts: Midterm Results

Abstract

Endovascular stent-graft implantation in descending thoracic aortic dissection is a feasible, safe, and effective treatment modality. However, further studies are necessary in a greater number of patients to determine if wider application of this minimally invasive procedure is justified.

Retrograde Type A Aortic Dissection After Endovascular Stent Graft Placement for Treatment of Type B Dissection

“…3,16,18,22,26 Interestingly, it was also observed in our center that post-stent grafting RTAD represented the most common complication among Marfan patients. In total, we have performed endografting in 6 type B dissections with Marfan syndrome, of whom 4 had solitary type B dissection and 2 previously underwent the Bentall procedure for type A dissection.…”

Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]24,[30][31][32][33][34][35] Among them, new entries were proximal to the endograft in 64 patients, [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]24,[30][31][32][33][34][35] and were at the distal end of the stent graft in 6. …”

“…3,18,20,22 The primary TEVAR was for aortic dissection in 64 patients [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]24,[30][31][32][33][34] and for descending thoracic aneurysm in 6. 13,17,21,24,35 SINE caused 28 cases (40%), [4][5][7][8][12][13][14][15]18,20,22,24,[31][32][33][34] natural disease progression caused 7, 10,11,13,15,18 and endovascular manipulation-related injury caused 11 (15.7%), includi...…”

“…A MEDLINE search found that much fewer post-TEVAR new entries were developing in aneurysm cases (n ϭ 6) 13,17,21,24,35 than in dissection patients (n ϭ 64). [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]24,[30][31][32][33][34] Similarly, no SINE was observed after TEVAR in the 39 patients with thoracic aortic aneurysms in our center to date, implicating the probability that a dissection was more prone to development of SINE than an aneurysm. Most commercial devices currently available have been designed for thoracic atherosclerotic aneurysms with strong radial force, and the diameter of both ends is usually identical or just had 2-mm tapering.…”

“…The limited information can only be obtained from solitary case reports 3 or extracted from studies about the general outcomes of TEVAR [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] or post-TEVAR retrograde type A dissection (RTAD). [23][24][25] METHODS Data collection and analysis.…”