Type a Dissection following Endovascular Thoracic Aortic Stent-Graft Repair

• Published in: Journal of endovascular therapy 2005-02, Vol.12 (1), p.74-81
• Main Authors: Neuhauser, Beate, Czermak, Benedikt V., Fish, John, Perkmann, Reinhold, Jaschke, Werner, Chemelli, Andreas, Fraedrich, Gustav
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Aneurysm, Dissecting - diagnostic imaging; Aneurysm, Dissecting - etiology; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - surgery; Angiography; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - methods; Cohort Studies; Female; Follow-Up Studies; Humans; Injury Severity Score; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Assessment; Stents - adverse effects; Survival Rate; Thoracic Injuries - diagnostic imaging; Thoracic Injuries - surgery; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 1526-6028; 1545-1550
• DOI: 10.1583/04-1369.1

Purpose: To describe our experience with endovascular stent-graft repairs in the thoracic aorta focusing on the secondary complication of type A dissection. Methods: Between January 1996 and April 2004, 73 patients were treated for traumatic thoracic aortic rupture (n=15), type B dissection (n=22), or atherosclerotic descending thoracic aortic aneurysms (TAA, n=36). A retrospective review of the records found 5 (6.8%) patients (3 men; median age 64 years, range 43–87) who experienced a type A dissection at a median 20 days (range 2–124) after thoracic stent-graft repair for 3 type B dissections, 1 TAA, and a late type I endoleak that appeared 28 months after initial stent-graft repair of a traumatic dissection. Results: In 3 patients (2 dissections, 1 endoleak), a tear in the aortic wall at the proximal stent-graft was responsible for a retrograde type A dissection. Underlying disease was the cause of the type A dissection in the 2 other patients (1 dissection, 1 TAA) and was unrelated to the stent-grafts. Three patients underwent open surgery at 3, 26, and 124 days after stent-graft placement; 2 procedures were successful, but the third patient died 3 months later due to multiorgan failure. Two type A dissections were untreated: one patient died from cardiac tamponade 14 days after successful stent-graft exclusion of the type I endoleak; the other patient refused further treatment and survived. The procedure-related mortality following acute retrograde type A dissection was 40%. Conclusions: Endovascular stent-graft repair of the thoracic aorta is associated with lower morbidity and mortality rates than surgical repair, although potentially lethal complications, acute or delayed, may occur.