Ulcer-like projections into the dilated false lumen after stent-graft placement for aortic dissection

Purpose: To describe the successful endovascular repair and regression of an extensive descending thoracoabdominal aortic dissection associated with thoracic and abdominal aortic aneurysms. Case Report: An 83-year-old man presented with acute chest pain and shortness of breath. A descending thoracoabdominal aortic dissection that extended from near the left subclavian artery (LSA) to the right common iliac artery was found on computed tomography. Separate aneurysms in the thoracic and abdominal aorta were also identified. Staged endovascular procedures were undertaken to (1) close the single entry site and exclude the aneurysm in the thoracic aorta with an AneuRx thoracic stent-graft, (2) exclude the abdominal aneurysm and distal re-entry site with a bifurcated AneuRx endograft, and (3) treat a newly dilated thoracic segment between the LSA and first thoracic stent-graft. At 1 year, the false lumen had completely disappeared, the thoracic aneurysm had collapsed onto the endograft, and the abdominal aneurysm had shrunk by 30%. Conclusions: The potential to treat extensive aortic dissections with the hope that they might regress is promising, but repair of highly complex lesions involving one or more aneurysms in addition to the dissection requires meticulous imaging studies both preoperatively and intraprocedurally.

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Predictors of return to work after open triple-branched stent graft placement for acute type A aortic dissection

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz236 ◽

2019 ◽

Vol 30 (1) ◽

pp. 99-106 ◽

Cited By ~ 1

Author(s):

Yanjuan Lin ◽

Yiping Chen ◽

Haoruo Zhang ◽

Yanchun Peng ◽

Sailan Li ◽

...

Keyword(s):

Aortic Dissection ◽

Return To Work ◽

Stent Graft ◽

Operating Time ◽

Acute Type ◽

Aortic Cross Clamp Time ◽

Aortic Cross Clamp ◽

Type A Aortic Dissection ◽

Graft Placement ◽

Returning To Work

Abstract OBJECTIVES To investigate the rate of returning to work within 12 months after open triple-branched stent graft placement in acute type A aortic dissection (AAAD) patients and the reasons why patients did not return to work. METHODS We conducted this cohort study of AAAD patients who were discharged alive from the hospital at Fujian Cardiac Center during the period 2013–2018. The collected data included the patients’ baseline characteristics, employment status at 12 months after AAAD and variables classifying the potential reasons for those who did not return to work at 12 months. We applied logistic regression to estimate the factors associated with returning to work at 12 months. RESULTS One year after AAAD hospitalization, of the 326 AAAD patients, 81 (24.8%) returned to work, 231 (70.9%) did not and 14 (4.3%) died. Among the 231 patients who did not return to work, 105 (45.5%) were unable to work because of AAAD and 36 (15.6%) lost job owing to AAAD. After adjustment for other risk factors, age, female sex, type of work, operating time, aortic cross-clamp time and length of intensive care unit (ICU) stay were still significantly associated with a lower chance of returning to work. CONCLUSIONS Less than 25% of the previously employed patients returned to work at 12 months after AAAD. Older age, female sex, manual or semi-skilled professional work, a longer operating time, a longer aortic cross-clamp time and a longer length of ICU stay were associated with a lower likelihood of returning to work.

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A Computational Fluid Dynamics Study Pre- and Post-Stent Graft Placement in an Acute Type B Aortic Dissection

Vascular and Endovascular Surgery ◽

10.1177/1538574410389342 ◽

2010 ◽

Vol 45 (2) ◽

pp. 157-164 ◽

Cited By ~ 40

Author(s):

Christof Karmonik ◽

Jean Bismuth ◽

Mark G. Davies ◽

Dipan J. Shah ◽

Houssam K. Younes ◽

...

Keyword(s):

Fluid Dynamics ◽

Computational Fluid Dynamics ◽

Aortic Dissection ◽

Stent Graft ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection ◽

Graft Placement

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How to Exclude the Dilated False Lumen in Patients after a Type B Aortic Dissection? The Cork in the Bottleneck

Journal of Endovascular Therapy ◽

10.1177/152660280301000213 ◽

2003 ◽

Vol 10 (2) ◽

pp. 244-248 ◽

Cited By ~ 16

Author(s):

Maartje C. Loubert ◽

Victor P.M. van der Hulst ◽

Cees De Vries ◽

Kees Bloemendaal ◽

Anco C. Vahl

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

Case Reports ◽

False Lumen ◽

Type B ◽

Type B Aortic Dissection ◽

Type B Dissection ◽

Occluder Device ◽

Stent Graft Implantation ◽

Graft Implantation

Purpose: To report techniques for excluding the dilated false lumen associated with chronic type B aortic dissection following placement of a stent-graft in the true lumen. Case Reports: Two patients underwent stent-graft implantation for a dilated false lumen after chronic aortic dissection, but the false lumen was not excluded from the circulation by this procedure. The false lumen was obliterated in one case with Greenfield filters and detachable balloons placed above a renal artery orifice that was perfused via the false lumen. This acted like “a cork in the bottleneck” to block retrograde flow into the thoracic portion of the false lumen above the blockade. In the other patient, an occluder device was used as the “cork.” In both cases, a good result was obtained. The occluder device is preferred because deployment is more controllable. Conclusions: An occluder device may be used like a cork in a bottle to exclude the dilated false lumen in the thoracic aorta after a type B dissection.

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