Problems encountered during and after stent-graft treatment of aortic dissection.

PURPOSE The authors report their experiences with the problems encountered during and after stent-graft placement in patients with aortic dissections. MATERIALS AND METHODS Between July 1994 and December 2003, stent-graft placement was performed in 60 patients with aortic dissections, 9 patients with Stanford type A dissection and 51 patients with type B. Ten patients had acute dissection and 50 patients had chronic dissection. Each patient was followed for 12 to 107 months (mean, 33 mo). All cases were retrospectively reviewed for any problem that occurred during and after the procedure. RESULTS During the procedure, there were two cases (3%) of stent-graft migration, one case (2%) of stent-graft torsion, two cases (3%) of stent-graft folding due to oversizing, three cases (5%) of persistent thoracic false lumen flow by the appearance of a hidden intimal tear, one case (2%) of new intimal tear that resulted in retrograde type A dissection, and 12 cases (20%) of type I endoleaks on aortograms taken immediately after the procedure. During the follow-up period, one case (2%) of transient cerebral ischemia, six cases (10%) of persistent type I endoleaks, two cases (3%) of type II endoleaks through the intercostal artery, four cases (7%) with progressive dilatation of abdominal false lumen, six cases (10%) of new intimal tears which resulted in saccular aneurysms (n=4) or new dissections (n=2) on either or both ends of the stent-graft, and two cases (3%) of mechanical failure were observed. Overall, five patients (8%) required surgical conversion, and there were no cases of procedure-related mortality. CONCLUSION Various problems can occur during and after stent-graft placement in aortic dissection. The thorough evaluation of preoperative imaging and close follow-up are mandatory to optimize the management of such problems.

[1]  D. Choi,et al.  Elective Stent-Graft Treatment of Aortic Dissections , 2004, Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists.

[2]  Luigi de Luca Tupputi Schinosa,et al.  Endovascular Treatment of Thoracic Aortic Disease: Four Years of Experience , 2004, Circulation.

[3]  Tony P. Smith,et al.  Antibiotic prophylaxis in interventional radiology. , 2004, Journal of vascular and interventional radiology : JVIR.

[4]  O. Steinmetz,et al.  Management Trends and Early Mortality Rates for Acute Type B Aortic Dissection: A 10-Year Single-Institution Experience , 2004, Annals of vascular surgery.

[5]  C. Marty-ané,et al.  Improvement in proximal aortic endograft fixation: an experimental study using different stent-grafts in human cadaveric aortas. , 2003 .

[6]  Leo P Lawler,et al.  Multidetector row computed tomography of the aorta and peripheral arteries. , 2003, Cardiology clinics.

[7]  B. Risberg,et al.  Endovascular Treatment of Type B Thoracic Aortic Dissections , 2003, Journal of cardiac surgery.

[8]  K. Eagle,et al.  Aortic Dissection: New Frontiers in Diagnosis and Management: Part II: Therapeutic Management and Follow-Up , 2003, Circulation.

[9]  K. Eagle,et al.  Aortic dissection: new frontiers in diagnosis and management: Part I: from etiology to diagnostic strategies. , 2003, Circulation.

[10]  J. Lopera,et al.  Endovascular treatment of complicated type-B aortic dissection with stent-grafts:: midterm results. , 2003, Journal of vascular and interventional radiology : JVIR.

[11]  Rodney A. White,et al.  Guidelines for development and use of transluminally placed endovascular prosthetic grafts in the arterial system. , 1995, Journal of vascular and interventional radiology : JVIR.

[12]  Larry H Hollier,et al.  Mechanical failure of prosthetic human implants: a 10-year experience with aortic stent graft devices. , 2003, Journal of vascular surgery.

[13]  L. Lönn,et al.  Endograft Therapy for Diseases of the Descending Thoracic Aorta: Results in 43 High-Risk Patients , 2002, Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists.

[14]  L. Sunder-Plassmann,et al.  Complications after Endovascular Repair of Type B Aortic Dissection , 2002, Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists.

[15]  K. Takeda,et al.  Transluminal Stent-Graft Placements for the Treatments of Acute Onset and Chronic Aortic Dissections , 2002, Circulation.

[16]  G. Fraedrich,et al.  Placement of endovascular stent-grafts for emergency treatment of acute disease of the descending thoracic aorta. , 2002, AJR. American journal of roentgenology.

[17]  K. Takeda,et al.  Midterm results of stent-graft repair of acute and chronic aortic dissection with descending tear: the complication-specific approach. , 2002, The Journal of thoracic and cardiovascular surgery.

[18]  S. F. Quinn,et al.  Percutaneous placement of a low-profile stent-graft device for aortic dissections. , 2002, Journal of vascular and interventional radiology : JVIR.

[19]  M. Czerny,et al.  Endoluminal stent-graft placement in patients with acute aortic dissection type B. , 2002, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[20]  D. C. Brewster,et al.  Evolving experience with thoracic aortic stent graft repair. , 2002, Journal of vascular surgery.

[21]  L. Sunder-Plassmann,et al.  Initial Experience with Intentional Stent-Graft Coverage of the Subclavian Artery during Endovascular Thoracic Aortic Repairs , 2002, Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists.

[22]  E. Buffolo,et al.  Self-expandable aortic stent-grafts for treatment of descending aortic dissections. , 2002, The Annals of thoracic surgery.

[23]  B. Prendergast,et al.  Aortic Dissection: Advances in Imaging and Endoluminal Repair , 2002, CardioVascular and Interventional Radiology.

[24]  K. Takeda,et al.  Aneurysmal degeneration of the aorta after stent-graft repair of acute aortic dissection. , 2001, Journal of vascular surgery.

[25]  K. Sung,et al.  Aortic dissection: percutaneous management with a separating stent-graft--preliminary results. , 2001, Radiology.

[26]  K. Takeda,et al.  Treatment of chronic aortic dissection by transluminal endovascular stent-graft placement: preliminary results. , 2001, Journal of vascular and interventional radiology : JVIR.

[27]  H. Kwon,et al.  Elective endovascular treatment of descending thoracic aortic aneurysms and chronic dissections with stent-grafts. , 2001, Journal of vascular and interventional radiology : JVIR.

[28]  R. Bale,et al.  Treatment of Stanford type B aortic dissection with stent-grafts: preliminary results. , 2000, Radiology.

[29]  J. Lammer,et al.  Thoracic aortic aneurysms: treatment with endovascular self-expandable stent grafts. , 2000, The Annals of thoracic surgery.

[30]  M. Horibe,et al.  Toward the best treatment for uncomplicated patients with type B acute aortic dissection: A consideration for sound surgical indication. , 1999, Circulation.

[31]  J. H. van Bockel,et al.  Stent attachment site-related endoleakage after stent graft treatment: An in vitro study of the effects of graft size, stent type, and atherosclerotic wall changes. , 1999, Journal of vascular surgery.

[32]  R. Fairman,et al.  Perigraft air, fever, and leukocytosis after endovascular repair of abdominal aortic aneurysms. , 1999, American journal of surgery.

[33]  T Hirano,et al.  Endovascular stent-graft placement for the treatment of acute aortic dissection. , 1999, The New England journal of medicine.

[34]  T. Resch,et al.  Distal migration of stent-grafts after endovascular repair of abdominal aortic aneurysms. , 1999, Journal of vascular and interventional radiology : JVIR.

[35]  S. Lansman,et al.  Selective management of acute type B aortic dissection: long-term follow-up. , 1996, The Annals of thoracic surgery.

[36]  R. S. Mitchell,et al.  Endovascular stent-graft repair of thoracic aortic aneurysms. , 1996, The Journal of thoracic and cardiovascular surgery.

[37]  D. C. Miller,et al.  Aortic dissection , 1995, Annals of vascular surgery.

[38]  J. Coselli,et al.  Variables predictive of outcome in 832 patients undergoing repairs of the descending thoracic aorta. , 1993, Chest.

[39]  A. Dinisdagama.  The Leriche memorial lecture. The surgical management of aortic dissection: from uniformity to diversity, a continuous challenge. , 1991 .

[40]  R. Dinsmore,et al.  Dissecting aneurysm of the aorta: aortographic features affecting prognosis. , 1972, Radiology.