#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Endovascular treatment of type B aortic dissection and ischaemic complications accompanying aortic dissections


Authors: D. Kučera 1,2;  M. Válka 1;  J. Kozák 1;  J. Bezecný 1;  J. Krátký 1;  V. Jetmar 1
Authors‘ workplace: Vaskulární centrum, Vítkovická nemocnice a. s, Ostrava 1;  II. interní klinika kardiologie a angiologie 1. LF UK a VFN v Praze 2
Published in: Kardiol Rev Int Med 2016, 18(3): 163-172

Overview

The topic of this paper is the endovascular treatment of thoracic aortic dissection Stanford type B and treatment of ischaemic complications associated with aortic dissection. This method leads to thrombosis of the false lumen in the descending thoracic aorta and its stabilisation, remodelling and prevention of subsequent rupture. We have demonstrated the positive impact of a successful endovascular treatment of aortic remodelling and consolidation within 3 years after the implantation of the stent graft. We have shown a gradual decline of the overall diameter of the aorta in the descending thoracic aorta, especially at the expense of reducing the volume of the false channel, with a gradual increase in the size of the true channel. This positive trend was present in patients treated in acute or subacute stages of dissection as well as in the chronic stage of aortic dilatation. Very interesting and important to us is the subsequent development of the overall width of the aorta, the false and true channel in the abdominal aorta, which is not treated with a stent graft, and in most cases, a perfusion of the false channel persists due to a re-entry at the site of a distance between visceral and renal arteries. Despite the false channel perfusion, however, there is no dilatation of the abdominal aorta, and the size of the true and false channel does not change in time.

Keywords:
aortic dissection type B – true lumen – false lumen


Sources

1. Griepp RB, Ergin MA, Galla JD et al. Natural history of descending thoracic and thoracoabdominal aneurysms. Ann Thorac Surg 1999; 67: 1927–1930.

2. Hagan PG, Nienaber CA, Isselbacher EM et al. The International Registry of Acute Aortic Dissection (IRAD) – new insights into an old disease. JAMA 2000; 283: 897–903.

3. Hata H, Shiono M, Inoue T et al. Optimal treatment of type B acute aortic dissection: long-term medical follow-up results. Ann Thorac Surg 2003; 75: 1781–1784.

4. Hsu RB, Ho YL, Chen RJ et al. Outcome of medical and surgical treatment in patients with acute type B aortic dissection. Ann Thorac Surg 2005; 79: 790–794.

5. Nienaber CA, Fattori R, Lund G et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med 1999; 340: 1539–1545.

6. Lee DY, Williams DM, Abrams GD. The dissected aorta. part II. Differentiation of the true from the false lumen with intravascular US. Radiology 1997; 203: 32–36.

7. Schutz W, Gauss A, Meierhenrich R et al. Transesophageal echocardiographic guidance of thoracic aortic stent-graft implantation. J Endovasc Ther 2002; 9 (Suppl 2): 14–19.

8. Kato N, Shimono T, Hirano T et al. Midterm results of stent-graft repair of acute and chronic aortic dissection with descending tear: the complication specific approach. J Thorac Cardiovasc Surg 2002; 124: 306–312.

9. Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 1991; 5: 491–499.

10. Swee W, Dake MD. Endovascular management of thoracic dissections. Circulation 2008; 117: 1460–1473. doi: 10.1161/CIRCULATIONAHA.107.690966.

11. Geirsson A, Szeto WY, Pochettino A et al. Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations. Eur J Cardiothorac Surg 2007; 32: 255–262.

12. Garrett HE Jr., Wolf BA. Management of acute infrarenal aortic occlusion secondary to type A dissection. Ann Thorac Surg 2006; 81: 1500–1502.

13. Nienaber CA, Zannetti S, Barbieri B et al. INSTEAD Study Collaborators. INvestigation of STEnt grafts in patients with type B Aortic Dissection: design of the INSTEAD trial: a prospective, multicenter, european randomized trial. Am Heart J 2005; 149: 592–599.

14. Nienaber CA, Kische S, Rousseau H et al. Endovascular repair of type B aortic dissection long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv 2013; 6: 407–416. doi: 10.1161/CIRCINTERVENTIONS.113.000463.

Labels
Paediatric cardiology Internal medicine Cardiac surgery Cardiology

Article was published in

Cardiology Review

Issue 3

2016 Issue 3

Most read in this issue
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#