Kyobu geka. The Japanese journal of thoracic surgery · 2019
[Clinical Experience of Endovascular Stent-graft Treatment for Stanford Type A Acute Aortic Dissection].
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Uchida Tetsuro, Kuroda Yoshinori, Yamashita Atsushi, Hamasaki Azumi, Hirooka Shuto, Nakai Shingo, Kobayashi Kimihiro, Sadahiro Mitsuaki
Аннотация
BACKGROUNDS: Recently, thoracic endovascular aortic repair (TEVAR) is widely accepted and performed in patients with complicated and uncomplicated Stanford type B aortic dissection. However, TEVAR for Stanford type A aortic dissection is not commonly performed even in the endovascular era. This report describes patients who underwent TEVAR for Stanford type A dissection.
PATIENTS: Since 2016, 5 patients underwent TEVAR for retrograde acute Stanford type A dissection. A covered stent-graft was placed in the descending aorta for primary entry coverage. An additional bare-stent was placed in the narrowed true lumen of the downstream aorta. A thrombosed false lumen was observed in 4 and a partially thrombosed lumen in 1 patient. No patient showed pericardial effusion, aortic insufficiency, or persistent back pain. Four of 5 patients were asymptomatic, and only 1 patient developed multiorgan malperfusion. Repetitive computed tomography (CT) was performed postoperatively.
RESULTS: All patients underwent successful TEVAR without the need for additional intervention, and no operative mortality and morbidity were observed. The patient with multiorgan malperfusion recovered uneventfully without any complication. Follow-up CT revealed complete disappearance of the false lumen in the ascending aorta in all patients.
CONCLUSIONS: Although TEVAR of the descending aorta was performed with acceptable mortality and morbidity rates in strictly selected patients with retrograde Stanford type A dissection, conceptual and technical issues remain unresolved in patients with ascending aortic stent-graft placement. Technological advances would lead to the development of innovative disease-specific endovascular devices and solutions in the future for TEVAR in patients with Stanford type A dissection.
PATIENTS: Since 2016, 5 patients underwent TEVAR for retrograde acute Stanford type A dissection. A covered stent-graft was placed in the descending aorta for primary entry coverage. An additional bare-stent was placed in the narrowed true lumen of the downstream aorta. A thrombosed false lumen was observed in 4 and a partially thrombosed lumen in 1 patient. No patient showed pericardial effusion, aortic insufficiency, or persistent back pain. Four of 5 patients were asymptomatic, and only 1 patient developed multiorgan malperfusion. Repetitive computed tomography (CT) was performed postoperatively.
RESULTS: All patients underwent successful TEVAR without the need for additional intervention, and no operative mortality and morbidity were observed. The patient with multiorgan malperfusion recovered uneventfully without any complication. Follow-up CT revealed complete disappearance of the false lumen in the ascending aorta in all patients.
CONCLUSIONS: Although TEVAR of the descending aorta was performed with acceptable mortality and morbidity rates in strictly selected patients with retrograde Stanford type A dissection, conceptual and technical issues remain unresolved in patients with ascending aortic stent-graft placement. Technological advances would lead to the development of innovative disease-specific endovascular devices and solutions in the future for TEVAR in patients with Stanford type A dissection.