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Endovascular management of chronic post-dissection aneurysms
Kyriakos Oikonomou1, Athanasios Katsargyris1, Wolfgang Ritter1
11 Department of Vascular and Endovascular Surgery, and 2 Interventional Radiology, Paracelsus Medical University, Nuremberg, Germany.
Annals of Cardiothoracic Surgery
|June 27, 2014
Summary
Fenestrated and branched stent-grafts are feasible for treating chronic thoracoabdominal aneurysms after aortic dissection. This endovascular approach achieved technical success in all patients, with no paralysis observed.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Aortic Aneurysms
Background:
- Open repair remains the standard for acute type A dissection, while endovascular repair is used for complicated acute type B dissections.
- The efficacy of endovascular repair for chronic post-dissection aneurysms, particularly thoracoabdominal ones, is not well-established.
- Fenestrated/branched stent-grafts are effective for atherosclerotic thoracoabdominal aortic aneurysms but present unique challenges in post-dissection cases.
Purpose of the Study:
- To evaluate the feasibility and outcomes of endovascular repair using fenestrated/branched stent-grafts for chronic thoracoabdominal aneurysms following aortic dissection.
- To assess technical success, perioperative mortality, and long-term outcomes, including aneurysm-related mortality and reintervention rates.
Main Methods:
- Retrospective analysis of 17 patients with chronic thoracoabdominal aneurysmal degeneration post-dissection treated between January 2010 and November 2013.
- All patients underwent endovascular repair using fenestrated/branched stent-grafts.
- Outcomes assessed included technical success, perioperative mortality, paraplegia, aneurysm-related mortality, and reintervention rates during a median 12-month follow-up.
Main Results:
- Technical success was achieved in all 17 patients (100%).
- Two patients (11.8%) experienced perioperative mortality (one from multiple organ failure, one from cardiac failure).
- No cases of paraplegia were observed. Three patients required reintervention for type Ib endoleaks. No aneurysm-related deaths occurred during follow-up.
Conclusions:
- Endovascular treatment with fenestrated/branched stent-grafts is a feasible option for chronic post-dissection thoracoabdominal aortic aneurysms.
- While standard thoracic stent-grafting may apply to a minority of cases, fenestrated and branched devices are crucial for extensive thoracoabdominal involvement.
- The technique offers a viable alternative with acceptable outcomes, avoiding paraplegia in this challenging patient group.
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