BACKGROUND: Here we evaluate the usefulness of transfemoral uncovered stent implantation to avoid secondary conventional surgery for residual type A aortic dissection (TAAD) of the aortic arch after ascending aorta replacement. METHODS: From June 2009 to April 2015, 11 patients were treated with transfemoral implantation of uncovered stents in the aortic arch after surgical replacement of ascending aorta performed on average 4.7±2.3 years earlier. An enlarged dissected aortic arch or a dangerous median growth of more than 5 mm/yr or impending rupture presenting as chest pain were indications for treatment. The dissected aortic tracts diameter must not exceed 45 mm. Five patients (45.5%) were treated with Djumbodies Dissection System, 6 patients (54.5%) with Jotec E-XL aortic stent. RESULTS: There were no perioperative deaths or permanent neurologic complications. Primary procedural success was obtained in all patients and the residual TAAD in aortic arch was obliterated, with disappearance of the false lumen. Median intensive care unit (ICU) stay was 24 hours; post-operative hospital stay was 5.2±1.4 days. One death, not aortic related, occurred during follow-up period (mean 5.2±1.9 years). Descending thoracic aorta diameter significantly increased in 3 patients (27.3%): one patient (9.0%) needed a secondary conventional surgery, the other 2 (18.2%) of a distal extension with PETTICOAT approach. CONCLUSIONS: Endovascular approach with uncovered metal bare stent is surely an evolving strategy to perform a purely endovascular treatment, indicated only for treatment of an aortic arch with a diameter of less than 40 or 45 mm, to avoid progressive thoracic aortic dilatation and/or rupture.
BACKGROUND: Here we evaluate the usefulness of transfemoral uncovered stent implantation to avoid secondary conventional surgery for residual type A aortic dissection (TAAD) of the aortic arch after ascending aorta replacement. METHODS: From June 2009 to April 2015, 11 patients were treated with transfemoral implantation of uncovered stents in the aortic arch after surgical replacement of ascending aorta performed on average 4.7±2.3 years earlier. An enlarged dissected aortic arch or a dangerous median growth of more than 5 mm/yr or impending rupture presenting as chest pain were indications for treatment. The dissected aortic tracts diameter must not exceed 45 mm. Five patients (45.5%) were treated with Djumbodies Dissection System, 6 patients (54.5%) with Jotec E-XL aortic stent. RESULTS: There were no perioperative deaths or permanent neurologic complications. Primary procedural success was obtained in all patients and the residual TAAD in aortic arch was obliterated, with disappearance of the false lumen. Median intensive care unit (ICU) stay was 24 hours; post-operative hospital stay was 5.2±1.4 days. One death, not aortic related, occurred during follow-up period (mean 5.2±1.9 years). Descending thoracic aorta diameter significantly increased in 3 patients (27.3%): one patient (9.0%) needed a secondary conventional surgery, the other 2 (18.2%) of a distal extension with PETTICOAT approach. CONCLUSIONS: Endovascular approach with uncovered metal bare stent is surely an evolving strategy to perform a purely endovascular treatment, indicated only for treatment of an aortic arch with a diameter of less than 40 or 45 mm, to avoid progressive thoracic aortic dilatation and/or rupture.
Entities:
Keywords:
Type A aortic dissection (TAAD); endovascular treatment; uncovered stents
Authors: James C Halstead; Matthias Meier; Christian Etz; David Spielvogel; Carol Bodian; Michael Wurm; Rohit Shahani; Randall B Griepp Journal: J Thorac Cardiovasc Surg Date: 2006-12-04 Impact factor: 5.209
Authors: Santi Trimarchi; Christoph A Nienaber; Vincenzo Rampoldi; Truls Myrmel; Toru Suzuki; Rajendra H Mehta; Eduardo Bossone; Jeanna V Cooper; Dean E Smith; Lorenzo Menicanti; Alessandro Frigiola; Jae K Oh; Michael G Deeb; Eric M Isselbacher; Kim A Eagle Journal: J Thorac Cardiovasc Surg Date: 2005-01 Impact factor: 5.209
Authors: Christoph A Nienaber; Stephan Kische; Thomas Zeller; Tim C Rehders; Henrik Schneider; Björn Lorenzen; Carsten Bünger; Hüseyin Ince Journal: J Endovasc Ther Date: 2006-12 Impact factor: 3.487
Authors: Daniel Zimpfer; Martin Czerny; Joachim Kettenbach; Maria Schoder; Ernst Wolner; Johannes Lammer; Michael Grimm Journal: Ann Thorac Surg Date: 2006-08 Impact factor: 4.330
Authors: Lars G Svensson; Nicholas T Kouchoukos; D Craig Miller; Joseph E Bavaria; Joseph S Coselli; Michael A Curi; Holger Eggebrecht; John A Elefteriades; Raimund Erbel; Thomas G Gleason; Bruce W Lytle; R Scott Mitchell; Christoph A Nienaber; Eric E Roselli; Hazim J Safi; Richard J Shemin; Gregorio A Sicard; Thoralf M Sundt; Wilson Y Szeto; Grayson H Wheatley Journal: Ann Thorac Surg Date: 2008-01 Impact factor: 4.330