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Objectives To assess mid-term results of endovascular stent-graft repair in patients with complicated acute type B dissections..
Methods Between 11/96 and 06/04, 28 patients (20 men, 8 women; mean age, 60 years; range, 16 to 88 years) underwent endovascular stent-graft repair within 48 hours of the acute event. Complications included: contained rupture, major hemothorax, refractory chest pain unresponsive to medical therapy and severe or progressive visceral and/or lower limb ischemia. Stent-grafting was performed with first-generation (home-made) and second-generation (WL Gore Excluder®) stent-grafts. Follow-up was 96% complete and averaged 30 months ± 34. Post-procedure computed tomographic scans were used for surveillance.
Results. Early mortality was 21% (6/28)Major complications were aortic rupture and fatal ischemia . No neurological complications occurred. At the time of the latest scan: nine patients (32%) had a completely thrombosed false lumen, and it was partially thrombosed in 11 other patients (40%), aortic diameter increased significantly in 2 patients (7%),two patients (7%) with endoleaks ,one type I and one typeII .Actuarial survival estimate (± SEM) at 1 year was 76± 8%.There is no late mortality
Conclusion.
With follow-up now extending to 8 years, this report reveals that stent-grafting for patients with complicated acute type B dissections provides an effective option and may reduce mortality. Iatrogenic complications do occur, but are usually treatable. Despite or perhaps because of the stent-graft, aortic rupture and fatal ischemia can still occur. Earlier diagnosis and referral of moribund patients, better patient selection, and refinements in stent-graft design should improve future results.