Comparison of a Percutaneous Separate Stent Endograft and a Conventional Thoracic Stent-Graft for Endovascular Repair of Type B Aortic Dissection

Abstract

Purpose:

To compare the immediate and midterm outcomes of aortic dissection repair with a separate stent endograft (SSE) versus a conventionally constructed thoracic stent-graft.

Methods:

The records of 35 patients treated for type B aortic dissection from September 1997 to April 2003 were reviewed. Seventeen patients (12 men; mean age 58.8±11.6 years) underwent endovascular repair with a separate stent endograft (SSE), a custom-made device with a reduced profile suitable for percutaneous introduction through a 12-F sheath. Eighteen patients (10 men; mean age 56.1±12.8 years) underwent treatment with a conventional custom-made stent-graft.

Results:

Angiographic success was achieved in 13/17 (76.5%) of the SSE-treated patients and 12/18 (66.7%) for the conventional device group (p=0.521). Clinical success (complete obliteration/thrombosis of the false lumen) was achieved in 12/17 (70.6%) and 11/18 (61.1%), respectively (p=0.555). There were 2 cases of stent-graft movement during deployment and 2 access site complications in the conventional stent-graft group, whereas the SSE patients had no complications. Except for 2 conventional stent-graft patients who were lost to follow-up, all patients are alive at a mean 19.5±11.6 months for the SSE group and 34.2±21.5 months for the conventional stent-graft patients.

Conclusions:

The separate stent endograft can be deployed percutaneously without the need for blood pressure reduction, achieving accurate deployment without migration. In this small clinical experience, patients treated with the SSE had no access site complications and demonstrated midterm results comparable to the conventional stent-graft cohort, suggesting the possible usefulness of this device for the treatment of thoracic aortic dissection.

Keywords

Aortic dissection thoracic aorta stent-graft deployment techniques complications percutaneous delivery outcome analysis

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References

Wheat

. Current status of medical therapy of acute dissecting aneurysms of the aorta. World J Surg. 1980; 4: 563–569.

Elefteriades

Hartleroad

Gusberg

. Long-term experience with descending aortic dissection: The complication-specific approach. Ann Thorac Surg. 1992; 53: 11–21.

Crawford

Svensson

Coselli

. Aortic dissection and dissecting aortic aneurysms. Ann Surg. 1988; 208: 254–273.

Nienaber

Fattori

Lund

. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med. 1999; 340: 1539–1545.

Dake

Kato

Mitchell

. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med. 1999; 340: 1546–1552.

Czermak

Waldenberger

Fraedrich

. Treatment of Stanford type B aortic dissection with stent-grafts: Preliminary results. Radiology. 2000; 217: 544–550.

Dake

. Endovascular stent-graft management of thoracic aortic diseases. Eur J Radiol. 2001; 39: 42–49.

Dieter

. Transluminal endovascular stent grafting of aortic dissections and aneurysms: A concise review of the major trials. Clin Cardiol. 2001; 24: 358–363.

Greenberg

Resch

Nyman

. Endovascular repair of descending thoracic aortic aneurysms: An early experience with intermediate-term follow-up. J Vasc Surg. 2000; 31: 147–156.

10.

Won

Lee

Shim

. Elective endovascular treatment of descending thoracic aortic aneurysms and chronic dissections with stent-grafts. J Vasc Interv Radiol. 2001; 12: 575–582.

11.

Erbel

Alfonso

Boileau

. Diagnosis and management of aortic dissection. Eur Heart J. 2001; 22: 1642–1681.

12.

Slonim

Nyman

Semba

. Aortic dissection: Percutaneous management of ischemic complications with endovascular stents and fenestration. J Vasc Surg. 1996; 23: 241–253.

13.

Bachet

Guilmet

Rosier

. Protection of the spinal cord during surgery of thoracoabdominal aortic aneurysms. Eur J Cardiothorac Surg. 1996; 10: 817–825.

14.

Griepp

Ergin

Galla

. Looking for the artery of Adamkiewicz: A quest to minimize paraplegia after operations for aneurysms of the descending thoracic and thoracoabdominal aorta. J Thorac Cardiovasc Surg. 1996; 112: 1202–1213.

15.

Shim

Koo

Yoon

. Treatment of thoracic aortic dissection with stent-grafts: Midterm results. J Endovasc Ther. 2002; 9: 817–821.

16.

Kang

Lee

Maeda

. Aortic dissection: Percutaneous management with separating stent-graft, preliminary results. Radiology. 2001; 220: 533–539.

17.

Hagan

Nienaber

Isselbacher

. The international registry of acute aortic dissection (IRAD): New insights into an old disease. JAMA. 2000; 283: 897–903.

18.

Palma

de Souza

Rodríguez

. Self-expandable aortic stent-grafts for treatment of descending aortic dissections. Ann Thorac Surg. 2002; 73: 1138–1142.

19.

Kato

Shimono

Hirano

. Midterm results of stent-graft repair of acute and chronic aortic dissection with descending tear: The complication-specific approach. J Thorac Cardiovasc Surg. 2002; 124: 306–312.

20.

Hausegger

Tiesenhausen

Schedlbauer

. Treatment of acute aortic type B dissection with stent-grafts. Cardiovasc Intervent Radiol. 2001; 24: 306–312.

21.

Kato

Hirano

Kawaguchi

. Aneurysmal degeneration of the aorta after stent-graft repair of acute aortic dissection. J Vasc Surg. 2001; 33: 513–518.

22.

Chen

Shim

Chang

. False aneurysms at both ends of a descending thoracic aortic stent-graft: Complication after endovascular repair of a penetrating atherosclerotic ulcer. J Endovasc Ther. 2003; 10: 249–253.

23.

Lopera

Patino

Urbina

. Endovascular treatment of complicated type-B aortic dissection with stent-grafts: Midterm results. J Vasc Interv Radiol. 2003; 14: 195–203.