Perioperative aortic dissection rupture after endovascular stent graft placement for treatment of type B dissection.

Abstract

BACKGROUND:

The perioperative aortic dissection (AD) rupture is a severe event after endovascular stent graft placement for treatment of type B AD. However, this life-threatening complication has not undergone systematic investigation. The aim of the study is to discuss the reasons of AD rupture after the procedure.

METHODS:

The medical record data of 563 Stanford type B AD patients who received thoracic endovascular repair from 2004 to December 2011 at our institution were collected and analyzed. Double entry and consistency checking were performed with Epidata software.

RESULTS:

Twelve patients died during the perioperation after thoracic endovascular repair, with an incidence of 2.1%, 66.6% were caused by aortic rupture and half of the aortic rupture deaths were caused by retrograde type A AD. In our study, 74% of the non-rupture surviving patients had the free-flow bare spring proximal stent implanted, compared with 100% of the aortic rupture patients (74% vs. 100%, P = 0.213). The aortic rupture patients are more likely to have ascending aortic diameters = 4 cm (62.5% vs. 9.0%, P = 0.032), involvement the aortic arch concavity (62% vs. 27%, P = 0.041) and have had multiple stents placed (P = 0.039).

CONCLUSIONS:

Thoracic AD endovascular repair is a safe and effective treatment option for AD with relative low in-hospital mortality. AD rupture may be more common in arch stent-graft patients with an ascending aortic diameter = 4 cm and with severe dissection that needs multi-stent placement. Attention should be paid to a proximal bare spring stent that has a higher probability of inducing an AD rupture. Post balloon dilation should be performed with serious caution, particularly for the migration during dilation.

• Authors: Wen-hui Huang, Song-yuan Luo, Jian-fang Luo, Yuan Liu, Rui-xin Fan, Ling Xue, Fang Yang, Hui-yuan Kang, Meng-nan Gu, Zhen Liu, Nian-jin Xie, Hao-jian Dong, Zhong-han Ni, Mei-ping Huang, Ji-yan Chen
• Journal: Chinese medical journal (Chin Med J (Engl)) Vol. 126 Issue 9 Pg. 1636-41 ( 2013) ISSN: 2542-5641 [Electronic] China
• PMID: 23652043 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Aged, 80 and over
• Aortic Dissection (surgery)
• Aortic Aneurysm, Thoracic (surgery)
• Aortic Rupture (etiology)
• Blood Vessel Prosthesis Implantation
• Female
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Stents