Emergency Aortic Stent-grafting for Complicated DeBakey Type III Acute Aortic Dissection

DOI 10 References
  • Kurimoto Yoshihiko
    Department of Traumatology and Acute Care Medicine, Sapporo Medical University
  • Yanase Yousuke
    Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University
  • Uehara Mayuko
    Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University
  • Maeda Toshiyuki
    Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University
  • Uzuka Takeshi
    Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University
  • Koyanagi Tetsuya
    Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University
  • Ito Toshiro
    Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University
  • Kawaharada Nobuyoshi
    Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University
  • Asai Yasufumi
    Department of Traumatology and Acute Care Medicine, Sapporo Medical University
  • Higami Tetsuya
    Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University

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  • 合併症を発症した急性大動脈解離に対する緊急ステントグラフト内挿術の検討

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Abstract

Background: We report the usefulness of emergency thoracic endovascular aortic repair (TEVAR) for complicated acute type III aortic dissection. Methods: We studied a total of 20 patients with complications secondary to acute aortic dissection who were treated by emergency TEVAR from 2003 to 2010. Although fenestrated or non-fenestrated hand-made stent grafts (SG) were used in most cases, commercial SG have also been used, if anatomically suitable, since 2008. Results: The mean age was 69.7 years (range, 39-82) and there were 16 men in this study (80%). The types of aortic dissection were IIIa in 7 cases, IIIb in 8 and IIIbR in 5. Aortic dissection-related complications were rupture in 10 cases (50%), impending rupture in 5 (25%) and visceral or leg ischemia in 6, including 1 combined with rupture. A 79- and an 82-year-old patient with ruptured type IIIbR and IIIb aortic dissection, respectively, died due to re-rupture. The early mortality rate was 10%. Although 1 patient (5%) with left subclavian arterial dissection suffered cerebellar infarction following TEVAR, there were no cases of spinal cord ischemia as a complication of TEVAR. The thrombo-occlusion rate of type-IIIa false lumens was satisfactory (86%) in the follow-up period. The overall survival rate, aorta-related death-free rate and aorta-related event-free rate at 5 years after TEVAR were 73.5%, 100% and 84.4%, respectively. Conclusion: Emergency TEVAR was very useful for complicated acute aortic dissection. However, further investigation is necessary to more precisely define its indications for ruptured type IIIb aortic dissection.

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