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International Angiology 2013 October;32(5):483-91


language: English

Emergency endovascular stent-grafting for acute type B aortic dissection with symptomatic malperfusion

Shu C. 1, 2, Fang K. 1, 2, Luo M. 3, Li Q. 1, 2, Wang Z. 2, 4

1 Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China; 2 Hunan Major Vessels Center, Changsha, China; 3 Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; 4 Department of Vascular Surgery, Xuanwu Hospital, Capital University of Medical Sciences, Beijing, China;


Aim: The aim of this paper was to analyze the durability and efficacy of emergency thoracic endovascular aortic repair (TEVAR) for acute Stanford type B aortic dissection (TBAD) with malperfusion syndrome.
Methods: A retrospective analysis of acute TBAD with spinal cord, kidney, viscera, and extremity malperfusion was performed. Emergency TEVAR to cover primary tear site by stent-graft was strongly suggested to included candidates. Computed tomography (CT) scans and clinical findings were carried out in diagnosis and follow-up.
Results: One hundred twenty-seven TBAD patients (101 men, 46.1±11.4 year, range 34~76) who presented with acute end-organ malperfusion, including sudden paraplegia (N.=4), acute renal failure (N.=26), acute viscera ischemia (N.=61) and limb ischemia (N.=36), received aortic stent-grafting 2~48 hours after onset. Technical success was achieved in all primary TEVAR. The overall endoleak rate was 7.1% (9/127; typeI:3; typeII: 4; typeIV: 2). The 30-day mortality was 0.8% (2/127). 125 patients were followed for 19.1±14.5 (1~86) months, one patient died 50 days post-TEVAR due to myocardial infarction. Four patients required reintervention with additional stent grafts. Follow-up CT angiography showed enlargement of the true lumen and different degrees of thrombosis in the distal false lumen (complete thrombosis in 48, partial thrombosis in 52 and patency in 24).
Conclusion: Emergency TEVAR is an effective method to treat acute TBAD complicated with end-organ malperfusion. Covering of the proximal entry site of TBAD by stent-graft leads to flow increased in the true lumen and thrombosis of the false lumen of varying degree, which may improve end-organ perfusion and restore branch vessels patency.

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