True lumen obliteration in complicated aortic dissection: Endovascular treatment

被引:59
作者
Slonim, SM
Nyman, UR
Semba, CP
Miller, DC
Mitchell, RS
Dake, MD
机构
[1] STANFORD UNIV,MED CTR,DEPT RADIOL,STANFORD,CA 94305
[2] STANFORD UNIV,MED CTR,DEPT CARDIOVASC SURG,STANFORD,CA 94305
关键词
aorta; dissection; grafts and prostheses; stenosis or obstruction; transluminal angioplasty;
D O I
10.1148/radiology.201.1.8816538
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
PURPOSE: To evaluate endovascular treatment of ischemic complications caused by true lumen obliteration in aortic dissection. MATERIALS AND METHODS: Endovascular techniques were used to treat true lumen obliteration in 11 patients with complicated aortic dissection. In all cases, the true lumen was compressed to a paper-thin sliver by the expanded false lumen. Two patients had Stanford type A (chronic) and nine had type B (six acute, three chronic) dissections. Obliteration of the true lumen was associated with branch vessel ischemia that included renal (n = 7), mesenteric (n = 6), and lower-extremity (n = 6) arterial compromise. Two patients were treated with aortic stents, four with balloon fenestration of the intimal flap, and three with both stent placement and fenestration. In two patients, ischemic complications caused by true lumen obliteration could not be treated with endovascular techniques. RESULTS: Revascularization was technically successful with relief of clinical symptoms in nine patients. Revascularization was unsuccessful in one patient in whom surgical revascularization of the superior mesenteric artery was necessary and in one in whom hypertension was managed medically. One patient developed thrombosis of a renal artery in which a stent had been placed. The 30-day mortality rate was 9%, and the mean follow-up was 10.1 months (range, 2 weeks to 39 months). CONCLUSION: True lumen obliteration can be safely and effectively treated with endovascular stent placement and balloon fenestration.
引用
收藏
页码:161 / 166
页数:6
相关论文
共 23 条
[1]  
CAMBRIA RP, 1988, J VASC SURG, V7, P199
[2]   ENDOVASCULAR STENT FOR USE IN AORTIC DISSECTION - AN INVITRO EXPERIMENT [J].
CHARNSANGAVEJ, C ;
WALLACE, S ;
WRIGHT, KC ;
CARRASCO, CH ;
GIANTURCO, C .
RADIOLOGY, 1985, 157 (02) :323-324
[3]   LONG-TERM SURVIVAL OF PATIENTS WITH TREATED AORTIC DISSECTION [J].
DOROGHAZI, RM ;
SLATER, EE ;
DESANCTIS, RW ;
BUCKLEY, MJ ;
AUSTEN, WG ;
ROSENTHAL, S .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1984, 3 (04) :1026-1034
[4]   TREATMENT OF PATIENTS WITH AORTIC DISSECTION PRESENTING WITH PERIPHERAL VASCULAR COMPLICATIONS [J].
FANN, JI ;
SARRIS, GE ;
MITCHELL, RS ;
SHUMWAY, NE ;
STINSON, EB ;
OYER, PE ;
MILLER, DC .
ANNALS OF SURGERY, 1990, 212 (06) :705-713
[5]   PERCUTANEOUS FENESTRATION OF A TYPE-I AORTIC DISSECTION FOR RELIEF OF LOWER-EXTREMITY ISCHEMIA [J].
FAYKUS, MH ;
HIETTE, P ;
KOOPOT, R .
CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, 1992, 15 (03) :183-185
[6]   EXPERIMENTAL ASSESSMENT OF NEWLY DEVISED TRANSCATHETER STENT-GRAFT FOR AORTIC DISSECTION [J].
KATO, M ;
MATSUDA, T ;
KANEKO, M ;
UEDA, T ;
KURATANI, T ;
YOSHIOKA, Y ;
OHNISHI, K .
ANNALS OF THORACIC SURGERY, 1995, 59 (04) :908-915
[7]  
KATO M, 1993, ASAIO J, V39, P758
[8]   TREATMENT OF ACUTE AORTIC DISSECTIONS WITH EXPANDABLE METALLIC STENTS - EXPERIMENTAL-STUDY [J].
KATO, N ;
HIRANO, T ;
TAKEDA, K ;
NAKAGAWA, T ;
MIZUMOTO, T ;
YUASA, H .
JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY, 1994, 5 (03) :417-423
[9]   TREATMENT OF AORTIC DISSECTIONS WITH A PERCUTANEOUS INTRAVASCULAR ENDOPROSTHESIS - COMPARISON OF COVERED AND BARE STENTS [J].
KATO, N ;
HIRANO, T ;
TAKEDA, K ;
NAKAGAWA, T ;
MIZUMOTO, T ;
YUASA, H ;
SHIMIZU, Y .
JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY, 1994, 5 (06) :805-812
[10]   PERCUTANEOUS RECANALIZATION OF A RENAL-ARTERY IN AORTIC DISSECTION [J].
LACOMBE, P ;
MULOT, R ;
LABEDAN, F ;
JONDEAU, G ;
BARRE, O ;
CHAGNON, S ;
JUDET, O ;
TCHERDAKOFF, P .
RADIOLOGY, 1992, 185 (03) :829-831