Improved endovascular stent-graft exclusion for Debakey Ⅲ type aortic dissections

Wei LIAO; Jiumei CAI; Aiqin ZHOU

ABSTRACT

BACKGROUND:

Conventional endovascular stent-graft exclusion for Debakey Ⅲ type aortic dissection is complicated and the complication rates are relatively high. Moreover, their operating techniques have increased the risk of rupture of laminated break.

OBJECTIVE:

To evaluate the efficacy and safety of improved endovascular stent-graft exclusion for Debakey Ⅲ type aortic dissection by the innovative methods of interventional therapy. DESIGN, TIME AND

SETTING:

A retrospective case analysis. Cases were selected from Department of Cardiology, Affiliated Hospital of Gannan Medical College between October 2006 and March 2009.

PARTICIPANTS:

A total of 30 male patients with Debakey Ⅲ type aortic dissection were selected from Department of Cardiology, Affiliated Hospital of Gannan Medical College, aged 43-70(53.5±12.8) years. The time of onset was 5-45 days.

METHODS:

All patients underwent improved endovascular stent-graft exclusion for Debakey Ⅲ type aortic dissection by the innovative methods of intervsntional therapy. Fine wire bundled endovascular stent-graft were implanted by the innovative transmission and delivery methods in all patients, of which branch stent were implanted when the distance from the break of descending aorta to left subclavian artery was less than 10 mm. MAIN OUTCOME

MEASURES:

After the success of operation, aortic angiography was performed to detect stent-graft position, shape, break closure, internal leakage, and patency of the aortic arch branches. The situation of post-operative complications were observed. All cases were followed up by MRI to understand the complications such as aneurysm rupture, internal leakage and stent migration.

RESULTS:

A total of 33 fine wire bundled endovascular stent-graft were successfully implanted in 30 patients, including 4 branch stents. After the operation, 5 patients were verified endoleak, 3 of them were resolved by repeated stent distension and 2 were treated by implantation of another stent. Three months after the operation, 1 patient showed new rupture at the distal stent and then was successfully implanted a new stent. Three cases showed numbness of right lower extremity and 1 case showed intermittent claudication. In follow-up of 3-32 months, MRI scanning showed the reduction of the false cavity with the formation of intraluminal thrombus, the enlargement of true cavity, and no complications such as tumor rupture, internal leakage or stent displacement were found.

CONCLUSION:

Fine wire bundled endovascular stent-graft and the innovative methods of interventional therapy for endovascular thoracic aorta repair is an effective, less invasive and safe surgery with fast postoperative recovery, high success rate and few complications for patients with Debakey Ⅲ type aortic dissection, especially for high-risk patients.