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Endovascular stent-graft placement for complications of acute type B aortic dissection
Holger Eggebrecht1, Lars Lönn, Ulf Herold
1Department of Cardiology, West-German Heart Center Essen, University of Duisburg-Essen, Essen, Germany. holger.eggebrecht@uni-essen.de
Insights
Endovascular stent-graft placement offers a less invasive option for acute complicated type B aortic dissection. This approach shows feasibility and life-saving potential, though long-term durability requires further study.
Area of Science:
- Cardiovascular Surgery
- Vascular Endovascular Therapy
Background:
- Optimal treatment for Stanford type B aortic dissection (B-AD) is debated.
- Uncomplicated B-AD typically managed with strict antihypertensive therapy.
- Acute complicated B-AD presents significant therapeutic challenges due to high surgical morbidity and mortality.
Purpose of the Study:
- To review concepts and clinical outcomes of endovascular stent-graft placement for acute complicated type B aortic dissection.
Main Methods:
- Review of published studies on endovascular stent-graft placement for acute complicated B-AD.
- Analysis of early mortality rates and indications for the procedure.
Main Results:
- Endovascular stent-graft placement introduced in 1999 as a less invasive option.
- Indications include aortic rupture, branch vessel ischemia, expansion, or pain.
- Reported early mortality ranges from 0% to approximately 20%.
Conclusions:
- Limited but promising experience with endovascular stent-graft placement for acute complicated B-AD.
- Demonstrates feasibility and life-saving potential, avoiding open surgery trauma.
- Long-term results are necessary to evaluate treatment durability.
Purpose Of Review:
To review the concepts and current clinical results of endovascular stent-graft placement for acute complicated type B aortic dissection.
Recent Findings:
The optimal treatment for patients with dissections confined to the descending aorta (Stanford type B-AD) remains a matter of debate. Usually, antihypertensive medical therapy with strict blood pressure lowering below 135/80 mm Hg represents the first choice for patients with uncomplicated type B-AD. Patients with acute complicated type B-AD remain a major therapeutic challenge because surgery of the descending aorta is still associated with high morbidity and mortality. In 1999, endovascular stent-graft placement was introduced as a novel, less invasive treatment option for patients with type B aortic dissection. Current indications include acute (contained) aortic rupture, symptomatic ischemic branch vessel involvement, early aortic expansion, or unrelenting pain. So far, few studies on stent-graft placement in patients with acute complicated aortic dissection have been published reporting an early mortality between 0 and approximately 20%.
Summary:
To date, there is limited experience with endovascular stent-graft placement for acute complicated type B aortic dissection demonstrating its feasibility and life-saving potential. The endovascular approach can avoid the major trauma of open surgery and should help to get patients out of the acute life-threatening phase of the disease; however, long-term results are needed to assess the durability of this treatment.
