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J Thorac Cardiovasc Surg 2002;124:306-312
© 2002 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease (ACD)

Midterm results of stent-graft repair of acute and chronic aortic dissection with descending tear: The complication-specific approach

From the Departments of Radiology^a and Thoracic and Cardiovascular Surgery,^b Mie University Hospital, Mie, Japan, and the Department of Radiology,^c Matsusaka General Hospital, Matsusaka, Japan.

Received for publication Sept 18, 2001. Revisions requested Nov 16, 2001; revisions received Dec 3, 2001. Accepted for publication Dec 10, 2001. Address for reprints: Noriyuki Kato, MD, Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514, Japan (E-mail: kato{at}mri-gw.medic.mie-u.ac.jp).

Background: Endovascular stent-graft placement for the treatment of patients with aortic dissection is emerging as an attractive alternative to conventional cardiac operations. However, there has been no report of longer-term follow-up. The purpose of this study is to describe our midterm results with endovascular stent-graft repair for the treatment of patients with aortic dissections.
Methods: Thirty-eight patients with aortic dissections with descending tears were treated with endovascular stent-grafting. Ten patients had acute type A, 14 patients had acute type B, and 14 patients had chronic type B dissection. Stent grafts fabricated from expanded polytetrafluoroethylene-covered Z stents were placed to close entry tears in all patients through the delivery systems introduced from the femoral or the iliac arteries.
Results: Two patients with complicated acute type B dissection, who would have required surgical intervention, died within 30 days of the procedure, although no other patients died within the same period. There were no late deaths during the mean follow-up period of 27 months. Early and late complication rates were 33% and 36%, respectively, in patients with acute dissection, whereas rates were 4% and 0% (P < .05 vs patients with acute dissection) in patients with chronic dissection.
Conclusions: Entry closure with endovascular stent-graft placement may be a safe and effective method for the treatment of patients with aortic dissection. It could be an alternative to conventional surgical intervention in selected patients with chronic dissection. However, strict patient selection and close follow-up seem mandatory in patients with acute dissection receiving Z stent-based stent-grafts. Stent-graft repair should be delayed for acute type B dissection without complications.

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