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[Endovascular stent-graft exclusion for Stanford B type aortic dissections: a report of 146 patients]
Zai-ping Jing1, Xiang Feng, Jun-min Bao
1Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Institute of Vascular Surgery of People's Liberation Army, Shanghai 200433, China.
Insights
Endovascular stent-graft exclusion is a safe and effective treatment for thoracic aortic dissection (Stanford B). This minimally invasive procedure shows promising clinical outcomes for selected patients, though long-term effects require further study.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Interventional Radiology
Background:
- Aortic dissection, particularly Stanford B, presents significant therapeutic challenges.
- Endovascular stent-graft exclusion offers a less invasive alternative to open surgical repair.
Purpose of the Study:
- To evaluate the indications, preoperative assessment, surgical techniques, and clinical outcomes of endovascular stent-graft exclusion for aortic dissection.
Main Methods:
- 146 patients with Stanford B aortic dissection underwent endovascular stent-graft exclusion between 1998 and 2003.
- Preoperative evaluation utilized computed tomography angiography (CTA) or magnetic resonance angiography (MRA).
- The procedure involved inserting self-expanding stent-grafts via femoral or iliac arteries under digital subtraction angiography (DSA) guidance.
Main Results:
- Successful graft placement in 145 patients.
- Proximal tears excluded in 119 patients; both proximal and distal tears excluded in 26.
- Mean follow-up of 16 months revealed low perioperative mortality and morbidity, with good long-term outcomes for most patients.
Conclusions:
- Endovascular stent-graft exclusion is a safe and effective option for select patients with thoracic aortic dissection.
- Potential complications like endoleak necessitate vigilant monitoring.
- Long-term efficacy and safety require continued investigation.
Objective:
To assess the operation indications, preoperative evaluation, technique essentials and clinical prospect of endovascular stent-graft exclusion for aortic dissection.
Methods:
From September 1998 to April 2003, endovascular stent-graft exclusion for aortic dissection (Stanford B) was preformed in 146 patients. CTA or MRA were used as preoperative evaluation methods. Graft was constructed from self-expanding Z-stents covered with a woven Dacron polyester fabric graft (Talent). The stent-grafts were inserted from the femoral or iliac artery to exclude the tear of dissection, and all operations were performed under DSA guidance.
Results:
The grafts were installed successfully in 145 patients. In 119 patients only proximal tears were excluded, and 26 patients who had both the proximal and distal tears were excluded. The mean follow-up period was 16 months (1 - 54 months). Six patients died within the perioperative period, 2 patients died during the follow-up, 2 patients had recurrence of aortic dissection (Stanford A) and cured by Bentall operation. The others were in good state. No accidents related to the dissection and operation occurred.
Conclusions:
Endovascular graft exclusion may be a safe and effective treatment for selected patients with thoracic aortic dissection. Endoleak may lead to aneurysmal expansion and rupture. Further follow-up is necessary to evaluate its long-term effect.
