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Complicated acute type B dissections: a single-center experience with endovascular treatment
S Botsios1, K Schuermann, W Maatz
1Department of Thoracic- and Cardiovascular Surgery, St.-Johannes Hospital Dortmund, and Institute for Heart and Circulation Research, University Witten/Herdecke, Dortmund, Germany. botsios@arcor.de
Background:
Complicated acute type B dissections treated surgically carry a high risk of mortality. Endovascular interventions with stent-graft prostheses are a less invasive alternative and may obviate the need for surgery in most cases. We report here on our five years' experience with endovascular stenting in complicated acute type B dissections.
Patients And Methods:
Between March 2001 and January 2006, 32 patients (27 males, 5 females) with a mean age of 61.4+/-11.32 years (range 29-80) underwent stent grafting for complicated acute type B dissections. Indications were progression of dissection with impending rupture (n=10), uncontrollable hypertension (n=9), intractable thoracic pain (n=7), and malperfusion syndrome (n=6). Talent-Medtronic (n=34) and Excluder-Gore (n=3) stent-grafts were used. In 5 patients two stents were necessary. In addition to stent grafting, aortic fenestration was performed in all three cases with lower limb ischemia.
Results:
Endovascular stent placement was successful in all patients. Hospital mortality was 9.3% (3/32). No deaths occurred during follow-up (mean 32 months).
Conclusion:
Endovascular stenting of complicated acute type B dissections represents a safe alternative to surgery. Endovascular stent-grafts of appropriate sizes should be readily available in the hospital for emergency use, thus avoiding delays in treatment.
