Treatment of acute aortic type B dissection with stent-grafts

Purpose: To evaluate the feasibility of endoluminal stent-grafts in the tre atment of acute type B aortic dissections. Methods: In five patients with acute aortic type B dissections, sealing of the primary intimal tear with an endoluminal stent-graft was attempted. Ind ication for treatment was aneurysm formation in two patients and persistent pain in three patients. One of the latter also had an unstable dissection flap, compromising the ostium. of the superior mesenteric artery. The dista nce from the intimal tear to the left subclavian artery was <0.5 cm. in fou r patients, who had typical type B dissections., In one patient with an aty pical dissection the distance from the primary tear to the left subclavian artery was 4 cm. This patient had no re-entry tear. Talent tube Grafts (Wor ld Medical Manufacturing Cooperation, Sunrise, FL, USA) were used in all pa tients. Results: Stent-graft insertion with sealing of the primary tear was success ful in all patients. The proximal covered portion of the stent-graft was pl aced across the left subclavian artery in four patients (1 X transposition of the left subclavian artery). Left arm perfusion was preserved via a subc lavian steal phenomenon in the patients in whom the stent-graft covered the orifice of the left subclavian artery. The only procedural complication we observed was an asymptomatic segmental renal infarction in one patient. In the thoracic aorta thrombosis of the false aortic, lumen occurred in all p atients. In one patient the false lumen of the abdominal aorta thrombosed a fter 4 weeks; in the other three patients the status of the abdominal aorta remained unchanged compared with the situation prior, to stent-graft inser tion. As a late complication formation of a secondary aneurysm of the thora cic aorta was observed at the distal end, of the stent-graft 3 months after the primary intervention. This aneurysm was treated by coaxial insertion o f an additional stent-graft without complications. Conclusion: Endoluminal treatment of acute type B aortic dissections seems to be an attractive alternative treatment to surgical repair. Thrombosis of the false lumen of the thoracic aorta can be induced if the primary tear i s sealed with a stent-graft. This could protect the dissected thoracic aort a from delayed rupture.