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True lumen obliteration in complicated aortic dissection: endovascular treatment
S M Slonim1, U R Nyman, C P Semba
1Department of Radiology, Stanford University Medical Center, Calif, USA.
Insights
Endovascular repair effectively treats true lumen obliteration in aortic dissection, resolving ischemia in most patients. This approach offers a safe and successful alternative for managing complex aortic dissections.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Aortic Disease Management
Background:
- True lumen obliteration in aortic dissection leads to critical branch vessel ischemia.
- Endovascular techniques are increasingly explored for complex aortic pathologies.
Purpose of the Study:
- To evaluate the efficacy and safety of endovascular treatment for true lumen obliteration in aortic dissection.
- To assess outcomes of interventions like stent placement and balloon fenestration.
Main Methods:
- Retrospective analysis of 11 patients with complicated aortic dissection and true lumen obliteration.
- Interventions included aortic stent placement, balloon fenestration of the intimal flap, or a combination.
- Branch vessel ischemia involved renal, mesenteric, and lower-extremity arteries.
Main Results:
- Technical success and symptom relief achieved in 9 out of 11 patients.
- One patient required surgical intervention, and another was managed medically.
- A 9% 30-day mortality rate was observed, with a mean follow-up of 10.1 months.
Conclusions:
- Endovascular stent placement and balloon fenestration are safe and effective for treating true lumen obliteration.
- These minimally invasive techniques can successfully manage ischemic complications in selected aortic dissection patients.
Purpose:
To evaluate endovascular treatment of ischemic complications caused by true lumen obliteration in aortic dissection.
Materials And Methods:
Endovascular techniques were used to treat true lumen obliteration in 11 patients with complicated aortic dissection. In all cases, the true lumen was compressed to a paper-thin sliver by the expanded false lumen. Two patients had Stanford type A (chronic) and nine had type B (six acute, three chronic) dissections. Obliteration of the true lumen was associated with branch vessel ischemia that included renal (n = 7), mesenteric (n = 6), and lower-extremity (n = 6) arterial compromise. Two patients were treated with aortic stents, four with balloon fenestration of the intimal flap, and three with both stent placement and fenestration. In two patients, ischemic complications caused by true lumen obliteration could not be treated with endovascular techniques.
Results:
Revascularization was technically successful with relief of clinical symptoms in nine patients. Revascularization was unsuccessful in one patient in whom surgical revascularization of the superior mesenteric artery was necessary and in one in whom hypertension was managed medically. One patient developed thrombosis of a renal artery in which a stent had been placed. The 30-day mortality rate was 9%, and the mean follow-up was 10.1 months (range, 2 weeks to 39 months).
Conclusion:
True lumen obliteration can be safely and effectively treated with endovascular stent placement and balloon fenestration.