Single-branch endograft for treating stanford type B aortic dissections with entry tears in proximity to the left subclavian artery.

PURPOSE

To present a preliminary experience with a single-branch endograft for excluding Stanford type B aortic dissections with entry tears adjacent to the left subclavian artery (LSA).

METHODS

From February to August 2004, 16 symptomatic patients (15 men; mean age 57.8 years, range 41-73) having a Stanford B aortic dissection with a proximal tear <15 mm from the LSA orifice were treated with a single-branch thoracic endograft constructed of Z-shaped nitinol stents to which a Dacron graft had been sutured. The tubular main stent-graft had a branched segment connected to it for implantation in the LSA. The deployment method is the same as for a straight endograft except that the branch is deployed first in the LSA to stabilize the entire device. The main body of endograft is then deployed into the descending aorta to seal the tear, block flow from entering the false lumen, and enlarge the true lumen.

RESULTS

Sixteen branched endografts were deployed to seal the entry tears, with a technical success rate of 94% (15/16). One case was converted to surgery when the branch became trapped in the LSA at the left thoracic outlet. Two proximal endoleaks were treated with additional tubular endografts. All the proximal tears were sealed by the stent-grafts, and the compressed true lumens were widened. No paraplegia or distal organ or limb ischemia was noted, nor was there any mortality or complications. By 3 months post treatment, symptoms had abated, thrombosis had formed in the false lumen, and the true lumen had resumed its normal diameter in 15 of the 16 stent-graft patients. One patient has a distal re-entry at the level of the visceral arteries that is being observed.

CONCLUSIONS

The single-branch thoracic aortic endograft provides a simpler, safer, and more effective means of treating aortic dissections with entry tears in proximity to the LSA.