Uncovered stent implantation in complicated acute aortic dissection type B

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Aortic Diseases

Background:

• Complicated acute aortic dissection (cAADB) Stanford type B presents significant risks, particularly with visceral malperfusion.
• Prompt intervention is crucial for managing cAADB to prevent catastrophic outcomes.

Purpose of the Study:

• To assess the technical feasibility and midterm outcomes of using uncovered thoracoabdominal stents in patients with cAADB.
• To evaluate the efficacy of this minimally invasive technique in resolving visceral ischemia and claudication.

Main Methods:

• A retrospective review of 14 patients with cAADB experiencing symptomatic gastrointestinal malperfusion or claudication.
• Immediate implantation of uncovered stents into the true lumen of the thoracoabdominal aorta and visceral arteries.

Main Results:

• Successful elimination of gastrointestinal ischemia and symptoms in 13 of 14 patients.
• Despite initial stent collapse in 4 cases, all patients remained asymptomatic with adequate visceral artery perfusion.
• Only one patient required secondary surgical revascularization; long-term follow-up demonstrated sustained clinical benefit.

Conclusions:

• Thoracoabdominal uncovered stent implantation is a technically feasible and effective minimally invasive treatment for cAADB with visceral ischemia.
• The procedure successfully relieved acute visceral ischemia and claudication, offering a valuable therapeutic option.
• Attention to stent sizing is important to mitigate the risk of stent collapse and ensure long-term patency.