Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists · 2008
Intramural hematoma of the arch and ascending aorta owing to acute aortic syndrome of the descending aorta: to stent or not to stent?
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Dagenais François, Dumont Eric, Voisine Pierre
Аннотация
PURPOSE: To report thoracic stent-graft repair in patients with acute aortic syndromes, an intramural hematoma (IMH), and intractable pain despite maximum medical therapy.
CASE REPORTS: Since January 2002, 4 patients [2 men (40 and 53 years old) and 2 woman (62 and 83 years old)] with type B aortic dissection have presented with an IMH >3 mm in the aortic arch. The patients were treated with a "freeflo" Valiant thoracic stent-graft, which was deployed under "zero aortic pressure" using either adenosine arrest or rapid ventricular pacing. To enhance false lumen thrombosis, a distal extension was inserted when a significant re-entry was observed in the mid third of the descending thoracic. The procedures were successful; over a follow-up ranging to 17 months, the patients have been asymptomatic, with resolution of all the IMHs.
CONCLUSION: Thoracic stent-graft treatment of acute aortic syndromes of the descending aorta complicated by arch IMH is feasible. Success of the procedure may rely on optimal stent-graft selection with minimal graft oversizing, deployment under "zero aortic pressure" using rapid ventricular pacing, and more liberal revascularization of the left subclavian artery.
CASE REPORTS: Since January 2002, 4 patients [2 men (40 and 53 years old) and 2 woman (62 and 83 years old)] with type B aortic dissection have presented with an IMH >3 mm in the aortic arch. The patients were treated with a "freeflo" Valiant thoracic stent-graft, which was deployed under "zero aortic pressure" using either adenosine arrest or rapid ventricular pacing. To enhance false lumen thrombosis, a distal extension was inserted when a significant re-entry was observed in the mid third of the descending thoracic. The procedures were successful; over a follow-up ranging to 17 months, the patients have been asymptomatic, with resolution of all the IMHs.
CONCLUSION: Thoracic stent-graft treatment of acute aortic syndromes of the descending aorta complicated by arch IMH is feasible. Success of the procedure may rely on optimal stent-graft selection with minimal graft oversizing, deployment under "zero aortic pressure" using rapid ventricular pacing, and more liberal revascularization of the left subclavian artery.