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01-02-2009 | Vascular-Interventional

Percutaneous interventions for treating ischemic complications of aortic dissection

Authors: Ajay Chavan, Herbert Rosenthal, Lars Luthe, Stefanie Pfingsten, Ingo Kutschka, Jerry Easo, Siegfried Piepenbrock, Otto Dapunt, Axel Haverich, Michael Galanski

Published in: European Radiology | Issue 2/2009

Abstract

The aim of this study was to evaluate the role of percutaneous interventions in treating ischemia complicating aortic dissection. Forty-five patients with ischemia complicating aortic dissection were treated by balloon fenestration, true lumen stenting, angioplasty, or thrombolysis. Clinical and laboratory examinations were performed before and after intervention, and at the end of follow-up (median 37 months). Eighteen dissections were acute, 9 sub-acute, and 18 chronic. Mesenterohepatic ischemia resolved in 16 of 18 patients; lactate and SGOT values fell from 2.89 to 1.23 mmol/L (p = 0.006) and from 165.9 to 59.7 U/L (p = 0.034), respectively. In patients with renal ischemia, creatinine levels fell from 360.1 to 196.3 μmol/L (p = 0.007) accompanied by a significant reduction in blood pressure. Limb-threatening ischemia resolved in three of four patients; in 21 claudicants, the mean walking distance improved from 272 to 1,283 m (p = 0.001). Spinal ischemia resolved completely or partially in six of eight patients. Adjunctive surgical measures were necessary in six patients. Overall 30-day mortality in the 45 patients was 6.7%; all three deaths were in patients with acute dissections (mortality in this subgroup 16.7%). Ischemia complicating aortic dissection can be effectively treated by percutaneous interventions resulting in good early and mid-term outcomes.

Cambria RP, Brewster DC, Gertler J et al (1988) Vascular complications associated with spontaneous aortic dissection. J Vasc Surg 7:199–209PubMedCrossRef

Fann JI, Sarris GE, Mitchell RS et al (1990) Treatment of patients with aortic dissection presenting with peripheral vascular complications. Ann Surg 212:705–713PubMedCrossRef

Borst HG, Heinemann MK, Stone CD (eds) (1996) Surgical treatment of aortic dissection. Churchill Livingstone, New York, pp 249–271

Miller DC (1988) Vascular complications associated with spontaneous aortic dissection (discussion). J Vasc Surg 7:208–209

Elefteriades JA, Hammond GL, Gusberg RJ et al (1990) Fenestration revisited. A safe and effective procedure for descending aortic dissection. Arch Surg 125:786–790PubMed

Laas J, Heinemann M, Schaefers HJ et al (1991) Management of thoracoabdominal malperfusion in aortic dissection. Circulation 84(suppl III):III-20–III-24

Miller DC, Mitchell RS, Oyer PE et al (1984) Independent determinants of operative mortality for patients with aortic dissections. Circulation 70(suppl I):I–153

Williams DM, Brothers TE, Messina LM (1990) Relief of mesenteric ischemia in type III aortic dissection with percutaneous fenestration of the aortic septum. Radiology 174:450–452PubMed

Slonim SM, Nyman U, Semba CP et al (1996) Aortic dissection: percutaneous management of ischaemic complications with endovascular stents and balloon fenestration. J Vasc Surg 23:241–253PubMedCrossRef

10.

Slonim SM, Nyman U, Semba CP et al (1996) True lumen obliteration in complicated aortic dissection: endovascular treatment. Radiology 201:161–166PubMed

11.

Chavan A, Hausmann D, Dresler C et al (1997) Intravascular ultrasound-guided percutaneous fenestration of the intimal flap in the dissected aorta. Circulation 96:2124–2127PubMed

12.

Williams DM, Lee DY, Hamilton BH et al (1997) The dissected aorta: percutaneous treatment of ischemic complications - principles and results. JVIR 8:605–625PubMed

13.

Lacombe P, Mulot R, Labedan F et al (1992) Percutaneous recanalization of a renal artery in aortic dissection. Radiology 185:829–831PubMed

14.

Williams DM, Andrews JC, Marx V et al (1993) Creation of reentry tears in aortic dissection by means of percutaneous balloon fenestration: gross anatomic and histologic considerations. JVIR 4:75–83PubMed

15.

Walker PJ, Dake MD, Mitchell RS et al (1993) The use of endovascular techniques for the treatment of complications of aortic dissection. J Vasc Surg 18:1042–1051PubMedCrossRef

16.

Schild HH, Düber C, Grebe P et al (1994) Transvaskuläre Fensterung eines disseziierenden Aortenaneurysmas. Fortschr Röntgenstr 161,2:164–167CrossRef

17.

Trerotola SO (1996) Use of a stone basket as a target during fenestration of aortic dissection. JVIR 7:687–690PubMed

18.

Park JH, Chung JW, Cho YK et al (1997) Percutaneous fenestration of aortic dissection: salvage of an ischaemic solitary left kidney. Cardiovasc Intervent Radiol 20:146–148PubMedCrossRef

19.

Yamakado K, Takeda K, Nomura Y et al (1998) Relief of mesenteric ischemia by Z-stent placement into the superior mesenteric artery compressed by the false lumen of an aortic dissection. Cardiovasc Intervent Radiol 21:66–68PubMedCrossRef

20.

Slonim SM, Miller DC, Mitchell RS et al (1999) Percutaneous balloon fenestration and stenting for life-threatening ischaemic complications in patients with acute aortic dissection. J Thorac Cardiovasc Surg 117:1118–1127PubMedCrossRef

21.

Manke C, Strotzer M, Seitz J et al (1999) Ischämische Komplikationen bei Aortendissektion - Perkutane Behandlung mit Ballonfensterung und Stentimplantation. Fortschr Röntgenstr 198–204

22.

Nyman U, Ivancev K, Gottsäter Anders et al (1999) Chronic aortic dissection: stenting of aortic true lumen obliteration with late dynamic variations of both lumens. Cardiovasc Intervent Radiol 22:135–149PubMedCrossRef

23.

Beregi JP, Prat A, Gaxotte V et al (2000) Endovascular treatment for dissection of the descending aorta. Lancet 356:482–483PubMedCrossRef

24.

Beregi J-P, Haulon S, Otal P et al (2003) Endovascular treatment of acute complications associated with aortic dissection: midterm results from a multicenter study. J Endovasc Ther 10:486–493PubMedCrossRef

25.

Hartnell GG, Gates J (2005) Aortic fenestration: a why, when and how-to guide. RadioGraphics 25:175–189PubMedCrossRef

26.

Husmann MJ, Kickuth R, Ludwig K et al (2006) Intravascular ultrasound-guided creation of re-entry sites to improve intermittent claudication in patients with aortic dissection. J Endovasc Ther 13:424–428PubMedCrossRef

27.

Vedantham S, Picus D, Sanchez LA et al (2003) Percutaneous management of ischemic complications in patients with type-B aortic dissection. J Vasc Interv Radiol 14:181–193PubMed

28.

Chavan A, Kutschka I, Rosenthal H et al (1999) Percutaneous management of ischemic complications of aortic dissection. Radiology 213(Suppl.):S 477

29.

Fann JI, Smith JA, Miller CD et al (1995) Surgical management of aortic dissection during a 30-year period. Circulation 92(suppl II):II–13–II-121

30.

Panneton JM, Teh SH, Cherry KJ et al (2000) Aortic fenestration for acute or chronic aortic dissection: an uncommon but effective procedure. J Vasc Surg 32:711–721PubMedCrossRef

31.

Kato M, Matsuda T, Kaneko M et al (1998) Outcomes of stent-graft treatment of false lumen in aortic dissection. Circulation 98:II–305–II-312

32.

Dake MD, Kato N, Mitchell RS et al (1999) Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med 340:1546–1552PubMedCrossRef

33.

Nienaber CA, Fattori R, Lund G et al (1999) Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med 340:1539–1545PubMedCrossRef

34.

Duebener LF, Lorenzen P, Richardt G et al (2004) Emergency endovascular stent-grafting for life-threatening acute type B aortic dissections. Ann Thorac Surg 78:1261–1267PubMedCrossRef

35.

Fattori R, Lovato L, Buttazzi K et al (2005) Extension of dissection in stent-graft treatment of type B aortic dissection: lessons learned from endovascular experience. J Endovasc Ther 12:306–311PubMedCrossRef

36.

Chung JW, Elkins C, Sakai T et al (2000) True-lumen collapse in aortic dissection. Part II. Evaluation of treatment methods in phantoms with pulsatile flow. Radiology 214:99–106PubMed

Title: Percutaneous interventions for treating ischemic complications of aortic dissection
Authors: Ajay Chavan
Herbert Rosenthal
Lars Luthe
Stefanie Pfingsten
Ingo Kutschka
Jerry Easo
Siegfried Piepenbrock
Otto Dapunt
Axel Haverich
Michael Galanski
Publication date: 01-02-2009
Publisher: Springer-Verlag
Published in: European Radiology / Issue 2/2009
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-008-1141-4

At a glance: The STEP trials

Springer Medicine

Percutaneous interventions for treating ischemic complications of aortic dissection

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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