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Home > Vascular Annual Meeting > pvss9_kasirajan_thoracic

PVSS9. Thoracic Endografts for Chronic Type B Aortic Dissections

Karthikeshwar Kasirajan, Ross Milner, Ravi Veeraswamy, Elliot Chaikof. 
Emory University Hospital, Atlanta, Ga.

OBJECTIVES: One-third of survivors of acute Type B aortic dissection progress to rupture or require surgical repair within 5 years due to progressive false lumen enlargement. This retrospective study was undertaken to evaluate the safety and efficacy of the use of thoracic stent grafts (TSG) for treatment of chronic type B aortic dissection.

METHODS: A total of 34 patients (males 20; mean age 56±3 yr) were treated over a 4-year period with custom (2) or the TAG endografts for proximal thoracic false lumen enlargement. The majority of patients were treated with a single component (n=28 [82%]). The mean maximal thoracic aneurysm diameter was 6.9±1 cm. The majority (n=25 [74%]) of patients had symptoms of chronic back pain. The mean time from the initial acute dissection was 4.3±0.8 yr. Two patients had Marfan’s syndrome.

RESULTS: All but one patient had successful exclusion of the proximal entry point. The majority (n=31 [91%]) of patients had routine coverage of the left subclavian artery. Bypass adjuncts to improve proximal landing zone included three ascending aorta to innominate and common carotid bypasses, two carotid to carotid and carotid to subclavian bypasses, one bilateral carotid to subclavian bypass, and one total abdominal visceral vessel debranching. None of the patients with isolated left subclavian occlusion required an adjunctive procedure. Perioperative complications included two deaths, one transient paraparesis and one paraplegia. Secondary endovascular interventions were required for two patients with type II endoleaks, one with a type III endoleak, and one distal flare perforation. One patient with a proximal type I endoleak had a successful open surgical conversion. An asymptomatic proximal extension of the aortic dissection was noted in one patient 6 months after initial treatment. At a mean follow-up of 11±8 months, 31 (91%) of patients had complete false lumen thrombosis across the stented segment. Among patients with false lumen thrombosis, 25 (80%) patients had no growth in the size of the aneurysm and 6 (19%) patients had a mean 3.3±1 mm decrease in the size of the maximal thoracic aortic diameter.

CONCLUSIONS: Despite continued perfusion of the false lumen distal to the stented segment, the majority of treated patients had thrombosis and stabilization of the aneurysmal portion of the false lumen. TSG appears to be a safe and effective therapy for patients with chronic type B dissection.