Anne Vendrell1, Julien Frandon2, Mathieu Rodiere2, Olivier Chavanon3, Jean-Philippe Baguet4, Ivan Bricault2, Bastien Boussat5, Gilbert Raymond Ferretti2, Frédéric Thony2. 1. Clinique Universitaire de Radiologie et d'Imagerie Médicale, Centre Hospitalier Universitaire de Grenoble, Grenoble, France. Electronic address: AVendrell@chu-grenoble.fr. 2. Clinique Universitaire de Radiologie et d'Imagerie Médicale, Centre Hospitalier Universitaire de Grenoble, Grenoble, France. 3. Clinique Universitaire de Chirurgie Cardio-Thoracique, Centre Hospitalier Universitaire de Grenoble, Grenoble, France. 4. Service de Cardiologie, Clinique des Eaux Claires, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France. 5. Université Joseph Fourier, Laboratoire de Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble (TIMC-IMAG), Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
Abstract
OBJECTIVE: To analyze the short- and long-term results of an original aortic fenestration method using the funnel technique during aortic dissection complicated by malperfusion syndrome. METHODS: The funnel technique consists of deployment of an uncovered aortic stent graft placed from the false to the right lumen through an intimal flap aortic fenestration made by balloon angioplasty. Twenty-eight patients presenting with an aortic dissection (type A, n = 19; type B, n = 9) were treated for malperfusion syndrome owing to dynamic compression (16 renal, 17 bowel, and 13 lower limb ischemia) using the aforementioned technique, and had follow-up evaluation at short term (30 days) and long term (mean: 55 ± 40 months). Eight patients had severe ischemia on arrival (6 bowel, 7 renal, 3 lower limb). RESULTS: Technical success was achieved in 27 of 28 patients (96%), and ischemic symptoms had disappeared in 25 of 28 patients (89%) at short-term follow up. Five patients presented postprocedure complications: 4 minor and 1 major with arterial thrombosis which caused technical failure (3.6%). The 30-day mortality rate was 7% (n = 2), related to bowel ischemia complications. At long-term follow up, 21 patients had a stable thoracic aortic diameter (91%). CONCLUSIONS: The funnel technique, in cases of malperfusion syndrome after aortic dissection, safely improves short- and long-term clinical outcome, and could represent an interesting alternative in the management of patients. The hemodynamic efficiency of this technique may account for a lower mortality in our series.
OBJECTIVE: To analyze the short- and long-term results of an original aortic fenestration method using the funnel technique during aortic dissection complicated by malperfusion syndrome. METHODS: The funnel technique consists of deployment of an uncovered aortic stent graft placed from the false to the right lumen through an intimal flap aortic fenestration made by balloon angioplasty. Twenty-eight patients presenting with an aortic dissection (type A, n = 19; type B, n = 9) were treated for malperfusion syndrome owing to dynamic compression (16 renal, 17 bowel, and 13 lower limb ischemia) using the aforementioned technique, and had follow-up evaluation at short term (30 days) and long term (mean: 55 ± 40 months). Eight patients had severe ischemia on arrival (6 bowel, 7 renal, 3 lower limb). RESULTS: Technical success was achieved in 27 of 28 patients (96%), and ischemic symptoms had disappeared in 25 of 28 patients (89%) at short-term follow up. Five patients presented postprocedure complications: 4 minor and 1 major with arterial thrombosis which caused technical failure (3.6%). The 30-day mortality rate was 7% (n = 2), related to bowel ischemia complications. At long-term follow up, 21 patients had a stable thoracic aortic diameter (91%). CONCLUSIONS: The funnel technique, in cases of malperfusion syndrome after aortic dissection, safely improves short- and long-term clinical outcome, and could represent an interesting alternative in the management of patients. The hemodynamic efficiency of this technique may account for a lower mortality in our series.