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J Thorac Cardiovasc Surg 1999;117:1118-1127
© 1999 Mosby, Inc.
SURGERY FOR ADULT CARDIOVASCULAR DISEASE |
From the Division of Cardiovascular and Interventional Radiology (S.M.S., C.P.S., M.K.R., M.D.D.) and the Department of Cardiovascular and Thoracic Surgery (D.C.M., R.S.M.), Stanford University School of Medicine, Stanford, Calif, and the Division of Cardiovascular and Interventional Radiology (S.M.S.), Palo Alto Veterans Administration Medical Center, Palo Alto, Calif.
Read at the Twenty-fourth Annual Meeting of The Western Thoracic Surgical Association, Whistler, British Columbia, June 24-27, 1998.
Received for publication July 15, 1998. Revisions requested Sept 8, 1998. Revisions received Nov 30, 1998. Accepted for publication Jan 28, 1999. Address for reprints: Suzanne M. Slonim, MD, Department of Radiology, Mail Stop 114, 3801 Miranda Ave, Palo Alto, CA 94304.
Objectives: Acute aortic dissection frequently causes life-threatening ischemia of end-organs, historically associated with mortality exceeding 60%. Reperfusion with the use of interventional radiologic methods has evolved as a promising treatment. We report results of our initial 6 years of experience with percutaneous balloon fenestration of the intimal flap and endovascular stenting.
Methods: Forty patients (32 male and 8 female) with a median age of 53 years (range 16-86 years) underwent percutaneous treatment for peripheral ischemic complications of 10 type A and 30 type B acute aortic dissections since 1991. Twenty patients had ischemia of multiple organ systems. Thirty patients had renal, 22 had leg, 18 had mesenteric, and 1 had arm ischemia.
Results: Fourteen patients were treated with stenting of either the true or false lumen combined with balloon fenestration of the intimal flap, 24 with stenting alone, and 2 with fenestration alone. Successful revascularization was achieved in 93% ± 4% (±70% confidence levels) of patients (37/40). Nine patients had procedure-related complications. The 30-day mortality rate was 25% ± 7% (10/40), often related to irreversible ischemia of intra-abdominal organs that was present before the procedure. Of the remaining 30 patients, 5 have died and the remaining 25 continue to have relief of ischemic symptoms at a mean follow-up of 29 months.
Conclusion: Percutaneous balloon fenestration of the intimal flap and endovascular stenting is an effective treatment for life-threatening ischemic complications of acute aortic dissection.
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