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Endovascular treatment of descending aortic dissection (type B): short- and medium-term results
E Flecher1, P Cluzel, N Bonnet
1Université Pierre-et-Marie-Curie Paris VI, AP-HP, Service de chirurgie cardiovasculaire et thoracique (Pr I. Gandjbakhch), Groupe hospitalier Pitié-Salpêtrière, Paris.
Background:
Optimal treatment of type B dissections is open to debate. The use of endoprostheses is an option that requires evaluation.
Aim:
To report our experience with endoprostheses in type B aortic dissections.
Methods:
We report our short- and medium-term results with covered prostheses for the treatment of acute (n=7) and chronic (n=28) type B aortic dissections. The criteria used to indicate treatment were the same as those usually used for surgery: acute complications or dilated aneurysm. Cover of the main intimal tear was obtained in all cases with an improvement in symptoms in patients with acute dissections.
Results:
Early mortality was 14.3% (five patients), linked in three cases to the occurrence of a retrograde dissection of the ascending aorta. No neurological complications were observed. Four patients required an additional endovascular and/or surgical procedure. On early control scans, complete thrombosis of the false lumen at the thoracic level was observed in 40% of cases, partial thrombosis in 42.8% and an absence of thrombosis in 11.4%. After a mean follow-up of 20.8 months, one patient died of a pneumopathy. No secondary aneurysm expansion was noted at the thoracic stage whereas three patients presented with dilation of the abdominal aorta.
Conclusion:
The results of treatment of type B dissections with covered endoprostheses are encouraging. However, the morbimortality associated with treatment and the uncertainty of long-term results do not allow the use of this therapeutic option outside the criteria usually recognized to indicate surgery.
