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Remodeling of the thoracic aorta after stent grafting of type B dissection: a Swedish multicenter study.

Resch, Tim LU ; Delle, M ; Falkenberg, M ; Ivancev, Krassi LU ; Konrad, P ; Larzon, T ; Lonn, L ; Malina, Martin LU ; Nyman, R and Sonesson, Björn LU , et al. (2006) In Journal of Cardiovascular Surgery 47(5). p.503-508
Abstract
Aim. Endovascular repair of complicated type B dissections has evolved as a promising alternative to open repair. Previous studies have indicated that continued false lumen flow is a predictor of continued aortic dilatation and risk of rupture during follow-up. This multicenter study was conducted to analyze the postoperative changes of the false lumen after endografting of complicated type B dissections. Methods. All patients treated with endovascular stent grafts for thoracic type B dissections at 5 major Vascular Centers in Sweden were identified through local databases. Review of charts and all available pre- and postoperative CT scans were performed to identify demographics, indications for repair as well as postoperative changes of... (More)
Aim. Endovascular repair of complicated type B dissections has evolved as a promising alternative to open repair. Previous studies have indicated that continued false lumen flow is a predictor of continued aortic dilatation and risk of rupture during follow-up. This multicenter study was conducted to analyze the postoperative changes of the false lumen after endografting of complicated type B dissections. Methods. All patients treated with endovascular stent grafts for thoracic type B dissections at 5 major Vascular Centers in Sweden were identified through local databases. Review of charts and all available pre- and postoperative CT scans were performed to identify demographics, indications for repair as well as postoperative changes of the aorta and false lumen. Results. A total of 129 patients treated for type B dissections between 1994 and December 2005 were identified. Median radiological follow-up was 14 months. Fourteen patients died perioperatively leaving 115 patients available for analysis. Seventy-four of these had CT imaging of sufficient quality for morphological analysis. The vast majority of acute patients were treated for rupture or end-organ ischemia whereas most chronic patients were treated for asymptomatic aneurysms. In 80% of patients, the false lumen thrombosed along the stent graft but it remained perfused distal to the stent graft fixation in 50% of patients. Only 5% of patients presented with aortic enlargement of the stent grafted area when adequate proximal sealing was achieved. The distal, uncovered aorta displayed expansion in 16% of patients. Conclusions. The stent grafted thoracic aorta after type B dissection appears to be stabilized by covering the primary entry site with a stent graft in the majority of both acute and chronic dissections. The uncovered portion of the aorta distal to the stent graft, however, remains at risk of continuous dilatation. Stent grafting for complicated type B thoracic dissections seems to be a treatment option with reasonable morbidity and mortality even though the incidence of severe complications is still significant. (Less)
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
thoracic aorta, aortic dissections, stents
in
Journal of Cardiovascular Surgery
volume
47
issue
5
pages
503 - 508
publisher
Edizioni Minerva Medica
external identifiers
  • wos:000241757300004
  • scopus:33750703651
ISSN
0021-9509
language
English
LU publication?
yes
additional info
The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Emergency medicine/Medicine/Surgery (013240200), Unit for Clinical Vascular Disease Research (013242410), Medical Radiology Unit (013241410)
id
45ffd6a8-a44a-46f2-8500-936c87f66e22 (old id 162384)
alternative location
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=17033599&dopt=Abstract
date added to LUP
2016-04-01 15:48:35
date last changed
2021-07-21 01:43:30
@article{45ffd6a8-a44a-46f2-8500-936c87f66e22,
  abstract     = {Aim. Endovascular repair of complicated type B dissections has evolved as a promising alternative to open repair. Previous studies have indicated that continued false lumen flow is a predictor of continued aortic dilatation and risk of rupture during follow-up. This multicenter study was conducted to analyze the postoperative changes of the false lumen after endografting of complicated type B dissections. Methods. All patients treated with endovascular stent grafts for thoracic type B dissections at 5 major Vascular Centers in Sweden were identified through local databases. Review of charts and all available pre- and postoperative CT scans were performed to identify demographics, indications for repair as well as postoperative changes of the aorta and false lumen. Results. A total of 129 patients treated for type B dissections between 1994 and December 2005 were identified. Median radiological follow-up was 14 months. Fourteen patients died perioperatively leaving 115 patients available for analysis. Seventy-four of these had CT imaging of sufficient quality for morphological analysis. The vast majority of acute patients were treated for rupture or end-organ ischemia whereas most chronic patients were treated for asymptomatic aneurysms. In 80% of patients, the false lumen thrombosed along the stent graft but it remained perfused distal to the stent graft fixation in 50% of patients. Only 5% of patients presented with aortic enlargement of the stent grafted area when adequate proximal sealing was achieved. The distal, uncovered aorta displayed expansion in 16% of patients. Conclusions. The stent grafted thoracic aorta after type B dissection appears to be stabilized by covering the primary entry site with a stent graft in the majority of both acute and chronic dissections. The uncovered portion of the aorta distal to the stent graft, however, remains at risk of continuous dilatation. Stent grafting for complicated type B thoracic dissections seems to be a treatment option with reasonable morbidity and mortality even though the incidence of severe complications is still significant.},
  author       = {Resch, Tim and Delle, M and Falkenberg, M and Ivancev, Krassi and Konrad, P and Larzon, T and Lonn, L and Malina, Martin and Nyman, R and Sonesson, Björn and Thelin, S},
  issn         = {0021-9509},
  language     = {eng},
  number       = {5},
  pages        = {503--508},
  publisher    = {Edizioni Minerva Medica},
  series       = {Journal of Cardiovascular Surgery},
  title        = {Remodeling of the thoracic aorta after stent grafting of type B dissection: a Swedish multicenter study.},
  url          = {http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=17033599&dopt=Abstract},
  volume       = {47},
  year         = {2006},
}