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Ann Thorac Surg 2007;83:1635-1639
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Endovascular Stent-Graft Placement of Aneurysms Involving the Descending Aorta Originating From Chronic Type B Dissections

Martin Czerny, MD*, Daniel Zimpfer, MD, Suzanne Rodler, MD, Martin Funovics, MD, Marion Dorfmeister, MS, Maria Schoder, MD, Gabriel Marta, MD, Ernst Weigang, MD, Roman Gottardi, MD, Johannes Lammer, MD, Ernst Wolner, MD, Michael Grimm, MD

Departments of Cardiothoracic Surgery and Interventional Radiology, University of Vienna Medical School, Vienna, Austria

Accepted for publication December 18, 2006.

* Address correspondence to Dr Czerny, Waehringer Guertel 18-20, Vienna A-1090, Austria (Email: martin.czerny{at}meduniwien.ac.at).

Background: The performance of endovascular stent-graft placement in patients suffering from aneurysms involving the descending aorta originating from chronic type B dissections is unclear.

Methods: Within a 2-year period, we treated 6 patients with this pathology. Four patients required extension of the proximal landing zone (autologous double transposition, n = 2; subclavian-to-carotid artery transposition, n = 2) before stent-graft placement.

Results: Supra-aortic rerouting procedures and endovascular stent-graft placement were performed successfully in all patients. Closure of the primary entry tear, full expansion of the stent-graft, and eventually, thrombosis of the false lumen was achieved in 5 patients. In 1 patient with a short proximal landing zone, a persisting type Ia endoleak was observed. In all patients with successful primary entry closure, a reduction in aneurysm diameter occurred. Mean follow-up is 16 months (range, 4 to 25).

Conclusions: Endovascular stent-graft placement of aneurysms involving the descending aorta originating from chronic type B dissections may serve as a valuable treatment option in this complex pathology. The chronic dissection membrane can be successfully compressed against large areas of the native aortic wall. A sufficient proximal landing zone is mandatory for early and late success.


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Invited commentary
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Ann. Thorac. Surg. 2007 83: 1640. [Extract] [Full Text] [PDF]



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