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2014 ; 3
(3
): 307-13
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Endovascular management of chronic post-dissection aneurysms
#MMPMID24967171
Oikonomou K
; Katsargyris A
; Ritter W
; Spinelli D
; Seto Y
; Verhoeven EL
Ann Cardiothorac Surg
2014[May]; 3
(3
): 307-13
PMID24967171
show ga
Open repair is still the gold standard in acute type A dissection. Endovascular
repair is advocated for complicated acute type B dissections. Recent evidence
also supports the role of endovascular repair in a larger proportion of
uncomplicated acute type B dissections. The role of endovascular repair in
chronic post-dissection aneurysms, however, is still unclear. Most commonly,
post-dissection aneurysms involve the thoracoabdominal aorta, making the use of
fenestrated/branched stent-grafts to achieve complete aneurysm exclusion
mandatory. These fenestrated/branched stent-grafts have been used with success in
atherosclerotic thoracoabdominal aortic aneurysms (TAAAs). In chronic
post-dissection aneurysms, however, additional technical challenges arise. The
usually narrow true lumen makes the use of branches more tedious and overall
planning difficult. A second technical challenge relates to the fact that
visceral branches can also originate from the false lumen. In such cases,
perforation of the stiff chronic dissection flap is required to obtain access to
the vessel. During the period January 2010 to November 2013, 17 patients (13
males, mean age 65±7.8 years) with chronic thoracoabdominal aneurismal
degeneration following acute dissection were treated in our department with the
use of fenestrated/branched stent-grafts. Technical success was achieved in all
cases (100%). Perioperative mortality was two (11.8%) patients. One patient died
due to multiple organ failure and one due to cardiac failure. No case of
paraplegia was observed. During a 12-month median follow-up (range, 4-28 months)
no aneurysm-related deaths were observed. Reintervention was required in three
cases to repair a type Ib endoleak from a side branch. Endovascular treatment
with fenestrated/branched stent-grafts is feasible for chronic post-dissection
aneurysms. Standard thoracic stent-grafting is an option in a minority of
patients, when the aneurysm is limited to the thoracic segment. Fenestrated and
branched devices can successfully be used for aneurysms extending to the
thoracoabdominal aorta.