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Percutaneous management of ischemic complications in patients with type-B aortic dissection
Suresh Vedantham1, Daniel Picus, Luis A Sanchez
1Mallinckrodt Institute of Radiology, Department of Surgery, Section of Cardiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St. Louis, Missouri 63110, USA. vedanthams@mir.wustl.edu
Purpose:
To review our experience with the use of percutaneous methods to manage the ischemic complications of type-B aortic dissection.
Materials And Methods:
Retrospective review of our interventional radiology database identified 11 patients with acute type-B aortic dissection who underwent 13 endovascular procedures to attempt revascularization of 23 ischemic vascular territories (four mesenteric, 11 renal, eight lower extremities). Percutaneous interventions included balloon fenestration (four patients), aortic true lumen stent placement (three patients), and branch vessel stent placement (eight patients).
Results:
Successful initial reperfusion of 21 of 23 vascular territories (91%) was achieved with use of percutaneous methods alone, with no 30-day mortality, in-hospital mortality, or paraplegia. One additional patient underwent successful initial treatment with use of a combined interventional/surgical approach to reperfuse an ischemic limb. One patient developed acute thrombosis of a dissected renal artery during stent placement. Increased aortic true lumen collapse later resulted in further ischemia in two patients. During follow-up (mean, 16 mo), no patient has had evidence of false lumen enlargement or late recurrent ischemia.
Conclusion:
Endovascular methods offer a less-morbid nonsurgical treatment alternative for patients with acute complicated type-B aortic dissection.