scholarly journals Management of Acute Uncomplicated Stanford B Aortic Dissection in The Era of Endovascular Repair: A Case Report

2020 ◽  
Vol 1 (3) ◽  
pp. 36-40
Author(s):  
Putri Annisa Kamila ◽  
Novi Kurnianingsih ◽  
Sasmojo Widito ◽  
Djanggan Sargowo ◽  
Budi Satrijo
Keyword(s):  
Aortic Dissection ◽  
Femoral Artery ◽  
Endovascular Repair ◽  
False Lumen ◽  
Long Term Results ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Medication Therapy ◽  
Type B Dissection ◽  
Stanford B

Introduction: Uncomplicated type B aortic dissections have been traditionally treated with medication therapy. While it may provide good short-term results, longterm prognosis may be less favorable. With improvements in endovascular repair and the potential risk of disease progression, thoracic endovascular aortic repair (TEVAR) has been considered inpatients with uncomplicated type B aortic dissection. We present the case of 78-year-old gentleman who presented with acute uncomplicated type B aortic dissection managed by endovascular repair Case illustration: A 78 year-old hypertensive patient admitted to the hospital with persistent chest discomfort and cough for 2 weeks. The CT aortic angiogram showed type B dissection. Based on the recent guidelines, TEVAR should be considered in patients with uncomplicated type B aortic dissection, thus we prepared the patient for TEVAR procedure. First we established multidisciplinary vascular team for the pre-procedural preparation of the patient. We perform careful measurement through detailed CT angiography reconstruction from carotid to femoral arteries. We found proximal diameter was 30-35mm, distal diameter was 23mm and landing zone right after left brachial ostium, suitable for stent graft Valiant Captivia 36-32x150mm. The CT also showed that both femoral artery were normal, we decided to use right femoral artery as the access. We proceed to the procedure 2 days later, under general anaesthesia, digital subtraction angiography revealed dissection of descending aorta, and selected device was inserted. Subsequent contrast injection revealed total occlusion of the false lumen. Patient was transferred to ICU for postprocedural care, and extubated the day after. The hospital stay was uneventful, and one-month follow up CT shows no endoleak. Conclusion : Management of uncomplicated Stanford B dissections is very challenging. TEVAR has emerged as an alternative to surgery with lower morbidity and mortality rates that might offer good long-term results.

Management of Residual False Lumen Flow After Thoracic Endovascular Repair in Chronic Type B Aortic Dissection

2020 ◽  
Vol 04 (05) ◽  
Author(s):  
Hervé Rousseau ◽  
Paul Revel-Mouroz ◽  
Charline Zadro ◽  
Camille Dambrin ◽  
Christophe Cron ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Endovascular Repair ◽  
False Lumen ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Chronic Type ◽  
Thoracic Endovascular Repair

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.

Thoracic endovascular repair for disseminated intravascular coagulation associated with chronic type B aortic dissection

Vascular ◽  
2020 ◽  
Vol 28 (6) ◽  
pp. 705-707
Author(s):  
Jumpei Yamamoto ◽  
Arudo Hiraoka ◽  
Hidenori Yoshitaka
Keyword(s):  
Aortic Dissection ◽  
Disseminated Intravascular Coagulation ◽  
Endovascular Repair ◽  
Rare Complication ◽  
False Lumen ◽  
Celiac Artery ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Chronic Type ◽  
Intravascular Coagulation

Objectives Chronic disseminated intravascular coagulation is a rare complication of aortic dissection, and its optimal treatment remains controversial. Methods We present a 78-year-old man with repeated hemorrhagic events by disseminated intravascular coagulation due to chronic aortic dissection treated by thoracic endovascular aortic repair. Results Computed tomography angiography at three months revealed a completely thrombosed false lumen from the distal aortic arch to the descending aorta at the celiac artery level. Platelets and D-dimer levels remained stable, and the patient was doing well without hemorrhagic complications. Conclusions Endovascular repair was effective for disseminated intravascular coagulation due to chronic type B aortic dissection.

scholarly journals Management of Uncomplicated Type B Aortic Dissection

Hearts ◽  
2020 ◽  
Vol 1 (1) ◽  
pp. 14-24
Author(s):  
Xun Yuan ◽  
Rachel E. Clough ◽  
Christoph A. Nienaber
Keyword(s):  
Aortic Dissection ◽  
Endovascular Repair ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Term Survival ◽  
Subacute Phase ◽  
Stent Grafting ◽  
Best Medical Treatment ◽  
Type B Dissection ◽  
Acute Dissection

Acute aortic dissection has an incidence of approximately half that of symptomatic abdominal and thoracic aneurysm of the aorta and more than twice the mortality of population-based controls. While urgent undelayed open surgery is the strategy of choice in proximal dissection, medical management has been the mainstay of treatment for uncomplicated distal or type B aortic dissection, but endovascular intervention is now considered a potential treatment option for all type B dissection due to its success in complicated cases. Endovascular repair can be technically demanding in aortic dissection, and timing of the repair can have a significant influence on anatomical and clinical outcome. Observational reports of feasibility and reasonable safety are flanked by only two randomised trials; the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) trial demonstrated improved remodelling in acute dissection and the INvestigation of STEnt grafts in patients with type B Aortic Dissections (INSTEAD) trial showed better long-term survival in patients treated endovascularly in the subacute phase. Meta-analyses and other large clinical studies have demonstrated mixed results. Due to some risks associated endovascular repair and the requirement of specialist aortic care (which is not always available), a pragmatic approach for current management could involve high intensity serial imaging in the acute phase of a type B aortic dissection, thereby identifying complicated cases for early intervention and selection of patients at high risk of disease progression for deferred endovascular management in the subacute phase within 90 days.

Endovascular Repair of Acute Type B Aortic Dissection: Long-Term Follow-Up of True and False Lumen Diameter Changes

2007 ◽  
Vol 83 (3) ◽  
pp. 1059-1066 ◽  
Author(s):  
Maria Schoder ◽  
Martin Czerny ◽  
Manfred Cejna ◽  
Thomas Rand ◽  
Alfred Stadler ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Endovascular Repair ◽  
False Lumen ◽  
Lumen Diameter ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Long Term Follow Up

scholarly journals Expanding Role of Endovascular Repair for Type B Aortic Dissection

2017 ◽  
Vol 01 (02) ◽  
pp. 089-095
Author(s):  
Sanjiv Sharma ◽  
Arun Sharma
Keyword(s):  
Aortic Dissection ◽  
Endovascular Repair ◽  
Adverse Outcome ◽  
Multislice Ct ◽  
Medical Emergency ◽  
Primary Therapy ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Type B Dissection

AbstractAortic dissection is a medical emergency that can quickly lead to death, despite optimal treatment. The Stanford classification is widely used and is in close relationship to clinical practice, as type A dissections require primary surgical repair whereas type B dissections are treated medically as initial treatment with surgery or endovascular repair (EVR) reserved for any complications. Multislice CT is the investigation of choice to establish the diagnosis and plan treatment strategies. Therapeutic strategies differ for treatment of an acute dissection compared with a chronic dissection. Traditionally, most institutions favor a “complication specific” approach for type B dissection with antihypertensive treatment and use of β-blockers as primary therapy. Surgery or EVR is reserved for patients with recurrent pain, life-threatening complications, or rapid aortic expansion. With above algorithms, there is evidence that 30 to 50% patients on conservative therapy develop serious morbidity or mortality over 5-year period. Clinical and imaging markers of adverse outcome are being identified to revise the management strategies and offer EVR to those at risk for adverse outcome. This is especially relevant in view of the fact that EVR for type B dissection is associated with procedural success in 99.2 ± 0.1% patients. Overall survival rates of 96.9% at 30 days, 96.7% at 6 months, 96.4% at 1 year, 95.6% at 2 years, and 95.2% at 5 years are reported after EVR in type B dissections. There is emerging evidence that EVR may be noninferior to surgery in this group of patients. These observations along with the development of dissection-specific device designs have the potential to rewrite the management algorithms for type B aortic dissection and define the role of EVR in this disease.

scholarly journals Creating an appropriate access for endovascular repair by replacing a dissected femoral artery in aortic dissection

2020 ◽  
Author(s):  
Kimihiro Kobayashi ◽  
Tetsuro Uchida ◽  
Atsushi Yamashita ◽  
Mitsuaki Sadahiro
Keyword(s):  
Aortic Dissection ◽  
Femoral Artery ◽  
Endovascular Repair ◽  
Type B ◽  
Type B Aortic Dissection ◽  
True Lumen ◽  
Transfemoral Approach ◽  
Arterial Conduit ◽  
Intimal Injury ◽  
Access Complications

Abstract Transfemoral endovascular repair has been widely accepted as an effective treatment for type B aortic dissection. However, if the dissection extends to the femoral artery, the transfemoral approach increases the risk of access complications. We describe a case of acute complicated type B aortic dissection involving the dissected bilateral femoral arteries. Successful endovascular repair without access complications was performed through an appropriate access route created by a femoral arterial conduit. We believe that this approach results in reliable cannulation of the true lumen and the reduction of the risk for intimal injury in aortic dissection with the dissected femoral artery.

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