Review And Mid-term Follow- Up Of 45 Patients Stanford Type B Aortic Dissections Treated By Endovascular Placement Of Stent-Grafts

Purpose:To introduce the experience of dealing with type-B aortic dissection by the endovascular treatment with use of stent-grafts and report the midterm results. Methods:We retrospectively studied 45 patients who had been treated form 2009 to 2013, combing with their preoperative imaging examination, DSA during the procedure and postoperative follow- up imaging data. There were 13 complicated cases including rupture and impending rupture(n=3), serious malperfusion of visceral organs(n=4) or extremities(n=5), acute penetrating aortic ulcer(n=l). Of all the patients, 38 cases were in acute stage, 7 cases were in subacute stage, and 27 cases in chronic stage. We observed the anatomical features and the complications of stent implantation such as endoleak, migration and fracture of stent-graft, as well as the situation of the arterial remolding during the follow- up and tried to figure out the high risk factors of the complications. Results:In TEVAR group, 51 stent-grafts were implanted, and two stents were used in three cases, three were used in two cases. There was no intraoperative death or conversion to standard open repair, the 30-day mortality was 4.44%. The mean follow-up period was 31.3±23.7 months. During the follow-up, there were 7 patients developed type-1 endoleak and 2 of them received secondary grant-shift, others sealed and relieved spontaneously in follow-up Period. Proximal false luman was expected to disappear(14/45,31.1%) and thrombosis(31/45,68.9%)while remote false luman was with a tendency to be stream flowing(27/45,60%). Conclusion:The endovascular repair is a safe, efficient and feasible therapy to aortic dissection with encouraging short and mid-term effect. Subacute stage is the best time for surgery and regular follow-up imaging is necessary. In addition, to avoid operation during acute stage if allowed might be helpful for patients.