Alexander Massmann1, Takashi Kunihara2, Peter Fries3, Günther Schneider3, Arno Buecker3, Hans-Joachim Schäfers4. 1. Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany. Electronic address: alexander.massmann@uks.eu. 2. The Cardiovascular Institute, Tokyo, Japan. 3. Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany. 4. Clinic of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany.
Abstract
OBJECTIVE: To retrospectively evaluate the technical feasibility and midterm results of uncovered thoracoabdominal stent placement in complicated acute aortic dissection Stanford type B (cAADB). PATIENTS AND METHODS: Fourteen consecutive patients (3 females; range, 44-71 years) with cAADB who had symptomatic gastrointestinal malperfusion and claudication underwent immediate uncovered stent implantation (diameter, 7-28 mm; length, 40-100 mm) into the true lumen of the thoracoabdominal aorta (n = 23) and visceral arteries (n = 5). RESULTS: Stenting resulted in elimination of gastrointestinal ischemia and symptoms in 13 of 14 patients; persisting symptoms led to secondary surgical revascularization in only 1 patient. More than 1 stent (≤ 4) was placed in 7 patients (2 celiac, 1 mesenteric, 2 renal, 8 aorto-iliac). Follow-up computed tomographic angiography (CTA) revealed collapse of 4 aortic stents (diameter, 9-25 mm; length, 100 mm) at 1 week in the absence of symptoms. Balloon reexpansion was possible in all 4 stents, but recollapse occurred within 1 month. Despite stent collapse, the patients remained asymptomatic; ultrasonography and CTA documented sufficient perfusion of the visceral arteries in all patients. Follow-up ranged from 6 months to 5 years (average, 2.5 years). Except for the patient who underwent iliacomesenteric bypass for unspecific abdominal pain, no other patient required additional interventional or surgical therapy. CONCLUSIONS: Acute aortic dissection with suspicion of visceral ischemia should prompt for immediate intervention. Thoracoabdominal uncovered stent implantation is a technically feasible and effective minimally invasive approach that provided successful relief of acute visceral ischemia and claudication in cAADB. Stent size should be less than the normal aortic diameter to avoid possible stent collapse.
OBJECTIVE: To retrospectively evaluate the technical feasibility and midterm results of uncovered thoracoabdominal stent placement in complicated acute aortic dissection Stanford type B (cAADB). PATIENTS AND METHODS: Fourteen consecutive patients (3 females; range, 44-71 years) with cAADB who had symptomatic gastrointestinal malperfusion and claudication underwent immediate uncovered stent implantation (diameter, 7-28 mm; length, 40-100 mm) into the true lumen of the thoracoabdominal aorta (n = 23) and visceral arteries (n = 5). RESULTS: Stenting resulted in elimination of gastrointestinal ischemia and symptoms in 13 of 14 patients; persisting symptoms led to secondary surgical revascularization in only 1 patient. More than 1 stent (≤ 4) was placed in 7 patients (2 celiac, 1 mesenteric, 2 renal, 8 aorto-iliac). Follow-up computed tomographic angiography (CTA) revealed collapse of 4 aortic stents (diameter, 9-25 mm; length, 100 mm) at 1 week in the absence of symptoms. Balloon reexpansion was possible in all 4 stents, but recollapse occurred within 1 month. Despite stent collapse, the patients remained asymptomatic; ultrasonography and CTA documented sufficient perfusion of the visceral arteries in all patients. Follow-up ranged from 6 months to 5 years (average, 2.5 years). Except for the patient who underwent iliacomesenteric bypass for unspecific abdominal pain, no other patient required additional interventional or surgical therapy. CONCLUSIONS: Acute aortic dissection with suspicion of visceral ischemia should prompt for immediate intervention. Thoracoabdominal uncovered stent implantation is a technically feasible and effective minimally invasive approach that provided successful relief of acute visceral ischemia and claudication in cAADB. Stent size should be less than the normal aortic diameter to avoid possible stent collapse.