Endovascular approaches to acute aortic type A dissection: a CT-based feasibility study

Area of Science:

• Cardiovascular Surgery
• Medical Imaging
• Endovascular Interventions

Background:

• Open graft replacement is standard for acute type A aortic dissections.
• A significant portion (20%) of patients are inoperable for open surgery.
• An endovascular approach is being investigated for this patient group.

Purpose of the Study:

• To assess the feasibility of endovascular repair for acute Stanford type A aortic dissections.
• To identify anatomical suitability for stentgraft implantation in patients unfit for open surgery.

Main Methods:

• Retrospective analysis of 102 patients with acute Stanford type A aortic dissection (2006-2009).
• Inclusion criteria: high-quality preoperative angio-CT scans analyzed on a 3D workstation.
• Evaluation of anatomical parameters including entry tear location and length, and aortic diameters.

Main Results:

• Endovascular repair was feasible in 37 patients using a tubular stentgraft.
• An additional 8 patients were candidates for tubular repair with a bypass.
• A further 13 patients were suitable for arch-branched stentgrafts.
• The median distance of the entry tear to the coronary artery was 23 mm.

Conclusions:

• Open repair remains the gold standard for acute type A aortic dissection.
• Approximately half of patients undergoing open repair could potentially benefit from endovascular repair.
• Endovascular repair represents a potential new treatment option requiring further evaluation.