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

2003 ◽  
Vol 10 (2) ◽  
pp. 244-248 ◽  
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.

scholarly journals How to Guide Stent-Graft Implantation in Type B Aortic Dissection?

Circulation ◽  
2005 ◽  
Vol 112 (9_supplement) ◽  
Author(s):  
Dietmar H. Koschyk ◽  
Christoph A. Nienaber ◽  
Malgorzata Knap ◽  
Thomas Hofmann ◽  
Yskert V. Kodolitsch ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Guide Wire ◽  
False Lumen ◽  
Entire Length ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Complex Anatomy ◽  
Stent Graft Implantation ◽  
Graft Implantation

Background— Despite growing interest in stent-graft implantation for type-B aortic dissection, there are no established recommendations to prepare and perform an implantation procedure. Methods and Results— We directly compared angiography (ANGIO), transesophageal echocardiography (TEE), and intravascular ultrasound (IVUS) intraprocedually before and after placement of 48 stent grafts in 42 consecutive patients (12 women, 61±11 years of age) with acute and chronic type-B aortic dissection for both usefulness and capability to guide aortic stent-graft implantation. Both IVUS and TEE are superior to ANGIO to identify multiple entries (52 and 43 versus 34; P <0.005 each), to diagnose false-lumen slow flow after stent-graft implantation (32 and 31 versus 24; P <0.005 each) and to detect incomplete stent apposition (18 and 16 versus 8; P <0.005 each). In comparison with ANGIO, guide wire position over the entire length of the aorta was documented more frequently by TEE and IVUS (40 and 42 versus 25; P <0.001 each). In 4 patients with abdominal extension of the dissection, only IVUS was able to accurately identify the false lumen over the entire length of the diseased aorta. TEE was superior to IVUS and ANGIO in the detection of endoleaks (5 versus 0 and 1; P <0.05 each). Intraprocedural ANGIO, TEE, and IVUS had been performed without complications in all patients. Conclusions— TEE in conjunction with ANGIO appears to be advantageous and adds incremental information to safely guide stent-graft placement in type-B aortic dissection. Additional use of IVUS was found to be helpful in patients with complex anatomy and abdominal extension of the dissection.

Complications after Endovascular Repair of Type B Aortic Dissection

2002 ◽  
Vol 9 (6) ◽  
pp. 822-828 ◽  
Author(s):  
Reinhard S. Pamler ◽  
Thomas Kotsis ◽  
Johannes Görich ◽  
Xaver Kapfer ◽  
Karl-Heinz Orend ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Stent Grafting ◽  
Stent Graft Implantation ◽  
Graft Implantation

Purpose: To outline the complications encountered after endoluminal treatment in patients with type B aortic dissection. Methods: Between 1999 and 2001, 14 patients (12 men; mean age 60.3 years, range 39–79) with isolated type B aortic dissection (13 chronic, 1 acute) underwent aortic stent-grafting. Three patients with chronic dissection presented an acute clinical picture and were managed emergently. The left subclavian artery was intentionally covered by the prosthesis in 9 patients. Follow-up studies were performed at 6-month intervals. Results: Stent-graft implantation was technically successful in all patients, but incomplete sealing (endoleak) of the entry site required additional proximal stent-graft implantation in 4. The left subclavian artery remained patent in 5 patients. Secondary conversion was required in 3 patients: 2 for acute type A dissection resulting from injury to the aortic arch by Talent endografts and a sustained hemorrhage (left hemothorax). In another patient, a secondary intramural hematoma subsided spontaneously. Anterior spinal artery syndrome in 1 patient persisted at 1 month. No bypass was necessary for the 9 patients with the covered left subclavian arteries. Mean follow-up was 14 months (range 1–23). Conclusions: Stent-grafting is feasible in patients with type B aortic dissection, although it is associated with a considerable rate of complications. Frank reporting of these sequelae for a variety of stent-grafts is of paramount importance to clarifying the limitations of the method.

Favorable Outcome of Endovascular Stent-Graft Implantation for Stanford Type B Aortic Dissection

2003 ◽  
Vol 33 (6) ◽  
pp. 457 ◽  
Author(s):  
Woong Chol Kang ◽  
Bo Young Joung ◽  
Young Guk Ko ◽  
Bon Kwon Koo ◽  
Donghoon Choi ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Favorable Outcome ◽  
Endovascular Stent ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Endovascular Stent Graft ◽  
Stent Graft Implantation ◽  
Stanford Type B ◽  
Graft Implantation

scholarly journals Placement of a branched stent graft into the false lumen of a chronic type B aortic dissection

2011 ◽  
Vol 54 (6) ◽  
pp. 1784-1787 ◽  
Author(s):  
Dominic Simring ◽  
Jowad Raja ◽  
Luke Morgan-Rowe ◽  
Julian Hague ◽  
Peter L. Harris ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
False Lumen ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Chronic Type

Hybrid Thoracic Stent Graft Repair of a Complex Type B Aortic Dissection in a Patient who Presented Three Weeks after Repair of a Type a Aortic Dissection

2008 ◽  
Vol 3 (3) ◽  
pp. 158-160
Author(s):  
Puja Gaur ◽  
Karthikeshwar Kasirajan ◽  
Daniel L. Miller ◽  
Thomas A. Vassiliades
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Hybrid Approach ◽  
False Lumen ◽  
Type A ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Type A Aortic Dissection ◽  
Stent Graft Repair ◽  
Thoracic Stent Graft

Long-term management after repair of a type A aortic dissection includes aggressive medical therapy and routine surveillance with serial imaging to ensure thrombosis of the false lumen. Retained patency of the false lumen can lead to either the development of a false lumen aneurysm with a subsequent rupture or extension of dissection. Typically such events occur late, usually months after repair, and are treated with either a conventional one-stage open thoracoabdominal repair or a two-stage “elephant trunk” procedure. However, most patients who undergo such procedures experience major complications and the procedure-related mortality rate is high. We present a unique case of a 61-year-old woman who presented with a ruptured type B aortic dissection 3 weeks after repair of a type A aortic dissection. She underwent an emergent thoracotomy and primary repair of the ruptured aorta followed by concomitant arch debranching and thoracic stent graft placement. Simultaneous surgical debranching with a median sternotomy and endovascular repair with stent grafts is an attractive hybrid approach in patients who present with an acute rupture of a false lumen aneurysm soon after initial repair of an aortic dissection, a situation in which a conventional repair is not feasible. This report emphasizes that hybrid thoracic stent graft repair should be considered for such high-risk patients in the near future as it offers them relatively lower morbidity and mortality compared with what is seen with conventional repairs.

Endovascular Aortic Repair With Castor Single-Branched Stent-Graft in Treatment of Acute Type B Aortic Syndrome and Aberrant Right Subclavian Artery

2021 ◽  
pp. 153857442110056
Author(s):  
Xinyan Pang ◽  
Shi Qiu ◽  
Chen Wang ◽  
Kai Liu ◽  
Xin Zhao ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Subclavian Artery ◽  
False Lumen ◽  
Endovascular Aortic Repair ◽  
Aberrant Right Subclavian Artery ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Aortic Repair

Objective: In this retrospective study, we presented the results of Castor single-branched stent-graft in a small series of patients with acute type B aortic syndrome and aberrant right subclavian artery (ARSA). Methods: Between January 2019 and November 2019, 5 patients were diagnosed with acute type B aortic syndrome and ARSA (4 patients with intramural hematoma and ARSA, 1 patient with type B aortic dissection and ARSA). All the patients underwent thoracic endovascular aortic repair (TEVAR) using Castor single-branched stent-graft. In-hospital and 3-month outcomes were collected. Results: The mean operative time was 116 ± 20.43 minutes (range 90-145). All the TEVAR procedures were successfully performed without conversion to open surgery (100% success rate). All the ARSAs of the 5 patients were revascularized in situ by Castor single-branched stent-grafts. No deaths and complications were observed in the 3-month follow-up. The maximal diameters of diseased aortas in the 4 patients with IMH decreased 3 months after TEVAR. The false lumen in the graft-covered segment was completely thrombosed in the patient with type B aortic dissection. Conclusions: Castor single-branched stent-graft may be a good choice in treatment of acute type B aortic syndrome and aberrant right subclavian artery.

scholarly journals Typical Retrograde Type A Dissection After Previous Type B Dissection

2021 ◽  
Vol 24 (3) ◽  
pp. E589-E592
Author(s):  
Zeyi Cheng ◽  
Jun Shi ◽  
Caixia Pe ◽  
Yingqiang Guo
Keyword(s):  
Back Pain ◽  
Type A ◽  
Endovascular Stent ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Type B Dissection ◽  
Type A Dissection ◽  
Stent Graft Implantation ◽  
Stanford Type B ◽  
Graft Implantation

Background: Stanford type B aortic dissection (TBAD) retrograde tears to Stanford type A AD (RTAAD) have been reported only rarely, but are often fatal. Early diagnosis and timely surgery are essential. We present a typical case of RTAAD after the tip of the stent directly damaged the ascending aorta wall. Case: A 71-year-old woman was admitted to our department for chest pain and back pain for 10 hours. She had undergone coated stent graft implantation surgery a month previously for TBAD. On first impression, we suspected the AD may have progressed or torn retrogradely. RTAAD was confirmed by computed tomography angiography, and we successfully performed open surgery. Conclusion: RTAAD should be suspected in patients with chest and back pain after endovascular stent repair. Prompt recognition is essential, and early surgical treatment is strongly recommended.

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