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Emergency Stent-Graft Placement in Thoracic Aortic Dissection and Evolving Rupture

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Background: Even with rapid diagnosis and effective medical treatment mortality in type B aortic dissection with evidence of extraaortic leakage of blood remains high. Considering a mortality rate of 29% to 50% associated with emergency surgical repair, the concept of endovascular stent-graft placement may become a life-saving option in impending or evolving rupture by endovascular sealing of the entry tear and subsequent abortion of leakage. Methods: The concept was tested by comparing short-term and 1-year outcomes of 11 patients after emergency endovascular stent-graft placement with historic-matched control patients subjected to conventional therapy. All patients had acute type B dissection complicated by loss of blood into periaortic spaces. Results: Emergency stent-graft placement was successful without periprocedural morbidity, aborted leakage, and ensured reconstruction of the dissected aorta; at a mean follow-up of 15 ± 6 months no death had occurred in the stent-graft group whereas four patients had died with conventional treatment (p < 0.05) . Conclusion: With appropriate logistics and expertise, type B aortic dissection with leakage and evolving rupture may benefit from nonsurgical reconstruction of the dissected segment by endovascular stent grafts.
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Document Type: Research Article

Publication date: September 1, 2003

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