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Endovascular treatment for chronic type B dissection: limitations of short stent-grafts revealed at midterm follow-up.

Manning, Brian J; Dias, Nuno LU ; Ohrlander, Thomas; Malina, Martin LU ; Sonesson, Björn LU ; Resch, Timothy and Ivancev, Krassi LU (2009) In Journal of Endovascular Therapy 16(5). p.590-597
Abstract
PURPOSE: To examine the incidence of and the indications for re-intervention, as well as the changes in aortic morphology, in patients with chronic type B aortic dissection who underwent endovascular intervention for false lumen aneurysms. METHODS: A retrospective analysis was conducted of 10 patients (8 men; mean age 63 years, range 45-79) who underwent stent-graft repair of aneurysmal false lumen expansion related to chronic type B aortic dissection at a median 16 months (range 2-71) from the initial diagnosis. All grafts had been oversized by 10% relative to the normal non-dissected aorta and were implanted to cover the primary entry tear. Follow-up computed tomography scans were analyzed to define changes in aortic morphology. RESULTS:... (More)
PURPOSE: To examine the incidence of and the indications for re-intervention, as well as the changes in aortic morphology, in patients with chronic type B aortic dissection who underwent endovascular intervention for false lumen aneurysms. METHODS: A retrospective analysis was conducted of 10 patients (8 men; mean age 63 years, range 45-79) who underwent stent-graft repair of aneurysmal false lumen expansion related to chronic type B aortic dissection at a median 16 months (range 2-71) from the initial diagnosis. All grafts had been oversized by 10% relative to the normal non-dissected aorta and were implanted to cover the primary entry tear. Follow-up computed tomography scans were analyzed to define changes in aortic morphology. RESULTS: Mean radiological follow-up was 56 months (median 64.5; range 19-86.5). There was no perioperative mortality or stroke; no cases of aortic rupture were recorded during follow-up. One patient suffered a procedure-related stroke with postoperative hemiparesis following re-intervention for proximal erosion 15 months after the initial treatment. In 6 of the 7 re-interventions performed in 6 patients at a median 42 months after the index procedure, stent-graft extension was required to treat erosion of the dissection membrane that had resulted in endoleak with false lumen reperfusion. The extent of dissection, duration of follow-up, or length of aortic coverage was not predictive of the need for re-intervention during follow-up. At last follow-up, the mean false lumen diameter at the level of the stented aorta was significantly smaller than at baseline (11+/-15 versus 24+/-15 mm, p<0.01). This was associated with false lumen thrombosis at the level of the stent-graft in 9 of 10 cases, although 7 patients had persistent false lumen perfusion distal to the stent-graft. CONCLUSION: Endovascular stent-graft treatment is effective therapy for chronic type B dissection patients with false lumen aneurysms. Erosion of the dissection membrane, causing proximal or distal endoleak, is the most common reason for re-intervention during midterm follow-up. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Endovascular Therapy
volume
16
issue
5
pages
590 - 597
publisher
International Society of Endovascular Specialists
external identifiers
  • wos:000271308800009
  • pmid:19842718
  • scopus:71949125356
ISSN
1545-1550
DOI
10.1583/09-2717.1
language
English
LU publication?
yes
id
a3dad1bf-1688-4d9e-a107-23f75f43a070 (old id 1500186)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19842718?dopt=Abstract
date added to LUP
2009-11-03 10:17:51
date last changed
2017-06-11 04:38:48
@article{a3dad1bf-1688-4d9e-a107-23f75f43a070,
  abstract     = {PURPOSE: To examine the incidence of and the indications for re-intervention, as well as the changes in aortic morphology, in patients with chronic type B aortic dissection who underwent endovascular intervention for false lumen aneurysms. METHODS: A retrospective analysis was conducted of 10 patients (8 men; mean age 63 years, range 45-79) who underwent stent-graft repair of aneurysmal false lumen expansion related to chronic type B aortic dissection at a median 16 months (range 2-71) from the initial diagnosis. All grafts had been oversized by 10% relative to the normal non-dissected aorta and were implanted to cover the primary entry tear. Follow-up computed tomography scans were analyzed to define changes in aortic morphology. RESULTS: Mean radiological follow-up was 56 months (median 64.5; range 19-86.5). There was no perioperative mortality or stroke; no cases of aortic rupture were recorded during follow-up. One patient suffered a procedure-related stroke with postoperative hemiparesis following re-intervention for proximal erosion 15 months after the initial treatment. In 6 of the 7 re-interventions performed in 6 patients at a median 42 months after the index procedure, stent-graft extension was required to treat erosion of the dissection membrane that had resulted in endoleak with false lumen reperfusion. The extent of dissection, duration of follow-up, or length of aortic coverage was not predictive of the need for re-intervention during follow-up. At last follow-up, the mean false lumen diameter at the level of the stented aorta was significantly smaller than at baseline (11+/-15 versus 24+/-15 mm, p&lt;0.01). This was associated with false lumen thrombosis at the level of the stent-graft in 9 of 10 cases, although 7 patients had persistent false lumen perfusion distal to the stent-graft. CONCLUSION: Endovascular stent-graft treatment is effective therapy for chronic type B dissection patients with false lumen aneurysms. Erosion of the dissection membrane, causing proximal or distal endoleak, is the most common reason for re-intervention during midterm follow-up.},
  author       = {Manning, Brian J and Dias, Nuno and Ohrlander, Thomas and Malina, Martin and Sonesson, Björn and Resch, Timothy and Ivancev, Krassi},
  issn         = {1545-1550},
  language     = {eng},
  number       = {5},
  pages        = {590--597},
  publisher    = {International Society of Endovascular Specialists},
  series       = {Journal of Endovascular Therapy},
  title        = {Endovascular treatment for chronic type B dissection: limitations of short stent-grafts revealed at midterm follow-up.},
  url          = {http://dx.doi.org/10.1583/09-2717.1},
  volume       = {16},
  year         = {2009},
}