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J Thorac Cardiovasc Surg 2006;132:361-368
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Complications after endovascular repair of acute symptomatic and chronic expanding Stanford type B aortic dissections

^a Department of Vascular and Endovascular Surgery, Ruprecht-Karls University Heidelberg, Germany
^b Department of Radiodiagnostics, Ruprecht-Karls University Heidelberg, Germany
^d Department of Anaesthesiology, Ruprecht-Karls University Heidelberg, Germany
^c Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.

Received for publication April 24, 2005; revisions received January 14, 2006; accepted for publication February 21, 2006.

^_* Address for reprints: Dittmar Böckler, MD, Abteilung für Gefäßchirurgie, Chirurgische Universitätsklinik Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg Germany. (Email: dittmar_boeckler{at}med.uni-heidelberg.de).

OBJECTIVE: To outline the complications after endovascular repair in patients with acute symptomatic and chronic expanding Stanford type B aortic dissections.

METHODS: Between 1997 and 2004, of 125 patients with acute and chronic aortic type B dissections, 88 were treated conservatively. Thirty-seven patients (29 male, mean age 58 years, range 30–82 years) underwent endovascular repair (30%) using 44 stent grafts of 3 different designs: Excluder (W. L. Gore & Associates, Inc, Flagstaff, Ariz), Talent (Medtronic Vascular, Santa Rosa, Calif), and Endofit (Endomed, Inc, Phoenix, Ariz). Indications for treatment were acute symptomatic type B dissection in 15 patients, chronic expanding aortic dissection greater than 55 mm in 14, rupture in 3, and simultaneous type A repair in 5 patients. Twenty-two operations were performed on an emergency basis. Patient characteristics, procedural variables, outcome, and complications were prospectively recorded. All patients underwent follow-up by computed tomography before discharge, at 6 and 12 months, and annually thereafter (mean follow-up: 24 months).

RESULTS: Correct deployment was achieved in 97% of cases. There were no instances of primary conversion, paraplegia, or stroke. Complete false lumen thrombosis was observed in 11 patients (44%). Perioperative complication rate was 22%. Thirty-day mortality rate in acute and chronic dissections was 19% and 0%, respectively. Freedom from aortic reintervention was 81%, 73%, and 68%, freedom from late rupture was 97%, 90%, and 80%, and overall success rate was 76%, 65%, and 57% at 1, 2, and 5 years, respectively. Results for patients with chronic dissections are significantly (P = .038) better than results in those with acute dissections.

CONCLUSIONS: Despite the minimally invasive approach, the complication and mortality rates for endovascular therapy of aortic dissections are still high. Frank reporting of these sequelae is if great importance to clarify the recent limitations of the method.

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