近端血管内支架移植联合远端裸金属支架置入治疗主动脉夹层

Background:Established endovascular treatments for aortic dissection often result in incomplete aortic repair, potentially leading to late complications involving the distal aorta. To address the problems of incomplete true lumen reconstitution and late aneurysmal change, we report the midterm results of combined proximal endografting with distal true lumen bare-metal stenting (STABLE: Staged Total Aortic and Branch vesseL Endovascular reconstruction) in Stanford type A and B aortic dissection. Methods:Between January 2003 and January 2010, 31 patients underwent staged total aortic and branch vessel endovascular reconstruction for management of acute (type A, 13; type B, 11) and chronic (type B, 7) aortic dissection. Proximal endografting was combined with bare-metal Z stent implantation in the distal true lumen. Patients with type A dissection underwent adjunctive treatment at operation. Computed tomography angiography was performed at baseline, 1year, and annually thereafter to assess aortic remodelling. Results:Primary technical success was 97%. Thirty-day rates of death, stroke, and permanent paraplegia/paresis were 3% (n=1), 0%, and 0%, respectively. Mean follow-up was 57.3months (range, 5 to 100months). Overall survival was 60% at 100months. Aortic-specific survival was 93%. Four patients (13%) underwent device-related reintervention. One (3%) late aortic-related death occurred. Thoracic (p=0.64) and abdominal (p=0.14) aortic dimensions were stable. The true lumen index increased significantly at follow-up. Conclusions:Staged total aortic and branch vessel endovascular reconstruction is a feasible ancillary endovascular technique to address the problems of distal true lumen collapse, incomplete aortic remodelling, and late aneurysm formation in aortic dissection (Fig 4).
Figure 4 Figure 4: (A, i; B, i, ii) Computed tomography angiography 4years after staged thoracoabdominal and branch vessel endoluminal repair demonstrates complete remodelling of the descending thoracic aorta. There was residual false lumen perfusion, but improved true lumen index without dilatation. (B, iii) Celiac axis perfusion was not compromised. (This article was published in The Annals of Thoracic Surgery, Hofferberth SC, Foley PT, Newcomb AE, et al. Combined proximal endografting with distal bare-metal stenting for management of aortic dissection. Ann Thorac Surg. 2012;93:95-102. © The Society of Thoracic Surgeons.)