Surgical interventions after emergency endovascular stent-grafting for acute type B aortic dissections.

In this retrospective study we reviewed our results of secondary surgery for complications after emergency placement of aortic stents for acute type B dissection. From October 2000 to June 2006, endovascular stent-grafting (ESG) was performed in 13 patients as an emergency procedure for acute type B dissection. Self-expanding nitinol stents (mean diameter 39.8+/-4.7 mm) were placed into the descending aorta distal to the left subclavian artery. In-hospital mortality was 15.4% (2/13) and related to persistent visceral malperfusion. Three patients (23%) required consecutive open surgery of the thoracic aorta after emergency endovascular stent-grafting for acute type B dissection. Indications for surgery included acute development of retrograde type A aortic dissection and acute stent dislocation by fractured wires and secondary leakage. Elective surgery was necessary in one patient 6 months after stent-grafting for late formation of an aneurysm of the descending aorta. There were no deaths or major morbidity after surgery of the thoracic aorta early or during follow-up. Mean follow-up was 38.0+/-13.9 months (range 1-70 months) and complete. We conclude from our study that stent-grafting of the descending aorta is a feasible, relatively safe and effective approach even in the emergency treatment of patients with complicated acute type B dissection. However, in a relevant number of patients emergency stent-grafting for acute type B aortic dissection results in complications that require secondary surgical treatment.