Experience of stent-graft repair in acute ascending aortic syndromes

Endovascular repair is an alternative to surgical treatment for ascending aortic syndromes for those at high risk. We present our experience of endovascular repair for acute type A aortic dissections and intramural hematomas and discuss the outcomes.

From January 2015 to May 2018, six patients diagnosed with acute type A aortic dissections or type A intramural hematoma underwent endovascular procedures in our hospital. The mean age of the patients was 58 ± 16 years, and the median follow-up was 11 months. The entry tear occurred in the ascending aorta in two patients (2 of 6) and the proximal descending aorta in four patients (4 of 6). All of the devices were delivered through the common femoral artery.

One was converted to open surgery (1 of 6), one suffered mortality (1 of 6), one had a neurological deficit irrelevant to the procedure, and one had postoperative renal failure. Four patients (4 of 6, 66.7%) had regression of false lumens in the ascending aorta. None of the cases required late reinterventions.

We concluded that endovascular repair may be an option for retrograde type A aortic dissections, but it may prove problematic when the entry tear is within the proximal half of the ascending aorta. Rigorous patient selection is crucial, lifelong imaging surveillance is necessary, and improving ascending aorta-specific devices may improve outcomes.