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Endovascular Treatment of Type B Thoracic Aortic Dissections

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Purpose: To evaluate the initial experience of endovascular repair of aortic dissections from a single center. Materials and Methods: From June 1999 to March 2002, endovascular stent grafting was performed in 20 high-risk patients (16 to 80 years). Eighteen patients had a type B dissection (14 acute and 4 chronic). Two patients had chronic type A dissection. Preoperative work-up included CT and MRI to evaluate the extent of the dissection, the relation to the left subclavian artery, the size of false and true lumen, and branch complications. Results: Stent-graft deployment was technically successful in all cases. None was converted to open repair. Three patients died within 30 days, i.e., a 15% mortality rate. Four patients (20%) had a perioperative stroke. Paraplegia was observed in one case. No migration of the stent grafts or endoleaks was observed during the mean follow-up period of 13 months. In all but two patient thrombosis of the false lumen was noted. Conclusions: Endovascular treatment of thoracic dissections is feasible. Early results are encouraging. While endovascular repair with stent-grafts is progressing rapidly as a viable strategy for aortic dissections in selected patients careful investigations must continue to focus on its safety. Randomized controlled trials are urgently needed. (J Card Surg 2003;18:539-544)
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Document Type: Research Article

Affiliations: 1: Departments of Interventional Radiology 2: Vascular Surgery 3: Cardiothoracic Surgery 4: Surgery, Sahlgrenska University Hospital, Göteborg, Sweden

Publication date: November 1, 2003

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