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Stent grafts for aortic dissection may be effective option in high-risk patients
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A novel endovascular repair strategy is an appropriate treatment option for ascending aortic dissections in patients who were considered unfit for urgent direct surgical repair, study results suggested.
Researchers enrolled 41 consecutive patients with ascending aortic dissections who were treated at a single site from May 2009 to January 2011. To define patients best suited for endovascular treatment, researchers divided the ascending aorta into three sections: entry tears in the distal third of the ascending aorta required a branched endograft or hybrid or fenestration procedure to maintain perfusion to brachial cephalic vessels; entry tears in the middle third of the ascending aorta were ideal cases for tube stent-graft repair; and entry tears in the proximal third did not offer a suitable proximal landing zone for the endograft.
Of the 41 patients, 15 underwent endovascular repair. Of the remaining patients, 21 underwent direct surgical repair and five were placed on best medical therapy.
Successful stent-graft deployment occurred in all patients, and there were no major morbidities or deaths perioperatively. During the median follow-up of 26 months, one new dissection occurred in the aortic arch at 3 months and was treated with a branched endograft. There were significant enlargements of true lumens and decreases of false lumens and overall thoracic aorta postoperatively.
“Transcatheter aortic valve replacement has become the standard of care under certain circumstances in many countries,” the researchers wrote. “It is conceivable that combining this technology with an endograft may make the possibility of treating ascending aortic dissections associated with compromised aortic valve function a reality.”
Disclosure: Researchers report no relevant financial disclosures.
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