Complicated acute type B dissections: a single-center experience with endovascular treatment.

BACKGROUND

Complicated acute type B dissections treated surgically carry a high risk of mortality. Endovascular interventions with stent-graft prostheses are a less invasive alternative and may obviate the need for surgery in most cases. We report here on our five years' experience with endovascular stenting in complicated acute type B dissections.

PATIENTS AND METHODS

Between March 2001 and January 2006, 32 patients (27 males, 5 females) with a mean age of 61.4+/-11.32 years (range 29-80) underwent stent grafting for complicated acute type B dissections. Indications were progression of dissection with impending rupture (n=10), uncontrollable hypertension (n=9), intractable thoracic pain (n=7), and malperfusion syndrome (n=6). Talent-Medtronic (n=34) and Excluder-Gore (n=3) stent-grafts were used. In 5 patients two stents were necessary. In addition to stent grafting, aortic fenestration was performed in all three cases with lower limb ischemia.

RESULTS

Endovascular stent placement was successful in all patients. Hospital mortality was 9.3% (3/32). No deaths occurred during follow-up (mean 32 months).

CONCLUSION

Endovascular stenting of complicated acute type B dissections represents a safe alternative to surgery. Endovascular stent-grafts of appropriate sizes should be readily available in the hospital for emergency use, thus avoiding delays in treatment.