Background
. Complete resection of the intimal tear in aortic arch is one of the most complicated tasks in the treatment of aortic dissections. We introduced open stent grafting technique to complete this task with technical easiness. In this study we evaluated the long term efficacy of this procedure from our 12 years experience.
Patients and Method.
Form January 1994 to December 2004, 59 aortic dissections with intimal tear in aortic arch or proximal descending aorta were operated with open stent grafting technique (age 61.7yrs, 41 type A and 18 type B). Thirty three (55.9%) were in emergency status. All these cases were morphologically excluded from the indication of transluminal endovascular repair. Under deep hypothermic circulatory arrest with antegrade cerebral perfusion, the hybrid prosthesis was inserted into descending aorta through the transected proximal aortic arch in order to achieve intimal tear exclusion.
Results.
Complete exclusion of the aortic arch intimal tear was achieved in all cases. Operative mortality within 30 days was 3.4%. Major postoperative complications included 4(6.8%) cerebral infarctions, 2 (3.4%) paraplegia, 2 (3.4%) transient paraparesis. Median follow up was 71.2 months (maximum 153 months). One patient (1.7%) showed type I endoleak from the distal end. In 6 patients (10.2%) additional endovascular repair for other thoracic lesions were performed, and only one case with Marfan syndrome required open surgical repair for thoracoabdominal aorta because of expansion of the remaining thoracic dissection. CT scan showed shrinkage of the false channel in 78.6% of the patients. There were no rupture of the remaining dissected aorta and the freedom from aortic related death was 94.7%, 94.7%, and 88.8% at 1,5, and 8 years respectively.
Conclusion.
This study suggested that open stent grafting is a safe and effective technique with good long-term results. This procedure could be an alternative and standard method to repair aortic dissections with aortic arch intimal tear.
Combined Fenestrated/Branched Endovascular Repair of the Aortic Arch and the Thoracoabdominal Aorta
