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Self-expandable aortic stent-grafts for treatment of descending aortic dissections
J Honório Palma1, Jose Augusto Marcondes de Souza, Claudia Maria Rodrigues Alves
1Cardiovascular Surgery, Medical School, São Paulo Federal University, São Paulo, Brazil. jhpalma.dcir@epm.br
Background:
Acute aortic dissection is a life-threatening medical condition that is associated with high morbidity and mortality.
Methods:
Of 198 patients treated with a self-expanding polyester-covered stent-graft for various pathologic aortic conditions in our institution, we selected 70 consecutive patients with type B aortic dissection who were undergoing treatment. The stent-graft was introduced through the femoral artery in the angiography suite, under general anesthesia with systemic heparinization and induced hypotension.
Results:
The procedure was performed in 70 patients; of these, 58 had descending aortic dissection and 12 had atypical dissections. The procedure was successful in 65 patients (92.9%), as documented by exclusion of the false lumen of the thoracic aorta. Eleven patients (18.9%) had persistent blood flow in the false lumen of the abdominal aorta due to distal reentries. Five patients (7.1%) underwent conversion to surgery. Insertion of additional stent-grafts was required in 34 patients (48.6%). At 29 months of follow-up, 91.4% of the patients were alive.
Conclusions:
Stent-grafts are an important means of treating aortic dissections, which may replace conventional medical treatment of this condition for the majority of patients.