Self-expandable aortic stent-grafts for treatment of descending aortic dissections

Background. Acute aortic dissection is a lifethreatening medical condition that is associated with high morbidity and mortality. Methods. Of 198 patients treated with a self-expanding polyester-covered stent-graft for various pathologic aortic conditions in our institution, we selected 70 consecutive patients with type B aortic dissection who were undergoing treatment. The stent-graft was introduced through the femoral artery in the angiography suite, under general anesthesia with systemic heparinization and induced hypotension. Results. The procedure was performed in 70 patients; of these, 58 had descending aortic dissection and 12 had atypical dissections. The procedure was successful in 65 patients (92.9%), as documented by exclusion of the false lumen of the thoracic aorta. Eleven patients (18.9%) had persistent blood flow in the false lumen of the abdominal aorta due to distal reentries. Five patients (7.1%) underwent conversion to surgery. Insertion of additional stent-grafts was required in 34 patients (48.6%). At 29 months of follow-up, 91.4% of the patients were alive. Conclusions. Stent-grafts are an important means of treating aortic dissections, which may replace conventional medical treatment of this condition for the majority of patients. (C) 2002 by The Society of Thoracic Surgeons.