Endovascular Treatment of Thoracic Dissection

H. Rousseau; O. Cosin; B. Marcheix; V. Chabbert; M. Midulla; C. Dambrin; C. Cron; B. Leobon; C. Conil; P. Massabuau; P. Otal; F. Joffre

doi:10.1055/s-2007-980041

Seminars in Interventional Radiology, Table of Contents

Semin intervent Radiol 2007; 24(2): 167-179
DOI: 10.1055/s-2007-980041

Endovascular Treatment of Thoracic Dissection

H. Rousseau¹ , O. Cosin¹ , B. Marcheix¹ , V. Chabbert¹ , M. Midulla¹ , C. Dambrin¹ , C. Cron¹ , B. Leobon¹ , C. Conil¹ , P. Massabuau¹ , P. Otal¹ , F. Joffre¹

¹Department of Radiology, Cardio-Vascular Surgery and Cardiology, Hôpital Rangueil, Toulouse, France

Abstract

ABSTRACT

Type A aortic dissection remains fatal if untreated. Although classical medical therapy for type B dissection is considered the therapy of choice in uncomplicated cases, the paradigm is changing as greater experience is accrued with endovascular treatments and technical advances improve the long-term outlook. Diagnosis is also becoming more sophisticated, allowing greater appreciation of the anatomy of dissections and improving the knowledge base as their natural history is assessed.

KEYWORDS

Aortic dissection - stent graft - multidetector computed tomography - transesophageal echocardiography

Full Text

References

REFERENCES

1 Meszaros I, Morocz J, Szlavi J et al.. Epidemiology and clinicopathology of aortic dissection. Chest. 2000; 117 1271-1278
2 Bickerstaff L K, Pairolero P C, Hollier L H et al.. Thoracic aortic aneurysms: a population-based study. Surgery. 1982; 92 1103-1108
3 Clouse W D, Hallett Jr J W, Schaff H V et al.. Acute aortic dissection: population-based incidence compared with degenerative aortic aneurysm rupture. Mayo Clin Proc. 2004; 79 176-180
4 Hagan P G, Nienaber C A, Isselbacher E M et al.. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000; 283 897-903
5 Nienaber C A, Fattori R, Mehta R H et al.. Gender-related differences in acute aortic dissection. Circulation. 2004; 109 3014-3021
6 Nienaber C A, Sievers H H. Intramural hematoma in acute aortic syndrome: more than one variant of dissection?. Circulation. 2002; 106 284-285
7 Moizumi Y, Komatsu T, Motoyoshi N, Tabayashi K. Clinical features and long-term outcome of type A and type B intramural hematoma of the aorta. J Thorac Cardiovasc Surg. 2004; 127 421-427
8 Movsowitz H D, Lampert C, Jacobs L E, Kotler M N. Penetrating atherosclerotic aortic ulcers. Am Heart J. 1994; 128 1210-1217
9 Ganaha F, Miller D C, Sugimoto K et al.. Prognosis of aortic intramural hematoma with and without penetrating atherosclerotic ulcer: a clinical and radiological analysis. Circulation. 2002; 106 342-348
10 Lesauskaite V, Tanganelli P, Sassi C et al.. Smooth muscle cells of the media in the dilatative pathology of ascending thoracic aorta: morphology, immunoreactivity for osteopontin, matrix metalloproteinases, and their inhibitors. Hum Pathol. 2001; 32 1003-1011
11 DeBakey M E, Beall Jr A C, Cooley D A et al.. Dissecting aneurysms of the aorta. Surg Clin North Am. 1966; 46 1045-1055
12 Daily P O, Trueblood H W, Stinson E B, Wuerflein R D, Shumway N E. Management of acute aortic dissections. Ann Thorac Surg. 1970; 10 237-247
13 Erbel R, Oelert H, Meyer J et al.. Effect of medical and surgical therapy on aortic dissection evaluated by transesophageal echocardiography: implications for prognosis and therapy. The European Cooperative Study Group on Echocardiography. Circulation. 1993; 87 1604-1615
14 Miller D C, Mitchell R S, Oyer P E, Stinson E B, Jamieson S W, Shumway N E. Independent determinants of operative mortality for patients with aortic dissections. Circulation. 1984; 70 I153-I164
15 Erbel R, Alfonso F, Boileau C et al.. Diagnosis and management of aortic dissection. Eur Heart J. 2001; 22 1642-1681
16 Mehta R H, Suzuki T, Hagan P G et al.. Predicting death in patients with acute type a aortic dissection. Circulation. 2002; 105 200-206
17 DeBakey M E, McCollum C H, Crawford E S et al.. Dissection and dissecting aneurysms of the aorta: twenty-year follow-up of five hundred twenty-seven patients treated surgically. Surgery. 1982; 92 1118-1134
18 Glower D D, Fann J I, Speier R H et al.. Comparison of medical and surgical therapy for uncomplicated descending aortic dissection. Circulation. 1990; 82(suppl) IV39-IV46
19 Schor J S, Yerlioglu M E, Galla J D, Lansman S L, Ergin M A, Griepp R B. Selective management of acute type B aortic dissection: long-term follow-up. Ann Thorac Surg. 1996; 61 1339-1341
20 Svensson L G, Crawford E S, Hess K R, Coselli J S, Safi H J. Dissection of the aorta and dissecting aortic aneurysms: improving early and long-term surgical results. Circulation. 1990; 82(suppl) IV24-IV38
21 Fann J I, Miller D C. Aortic dissection. Ann Vasc Surg. 1995; 9 311-323
22 Suzuki T, Mehta R H, Ince H et al.. Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD). Circulation. 2003; 108(suppl 1) II312-II317
23 Fann J I, Harris G E, Mitchell R S et al.. Treatment of patients with aortic dissection presenting with peripheral vascular complications. Ann Surg. 1990; 212 705-713
24 Cambria R P, Brewster D C, Gertler J et al.. Vascular complications associated with spontaneous aortic dissection. J Vasc Surg. 1988; 7 199-209
25 Laas J, Heinemann M, Schaefers H J, Daniel W, Borst H G. Management of thoracoabdominal malperfusion in aortic dissection. Circulation. 1991; 84(suppl) III20-III24
26 Bossone E, Rampoldi V, Nienaber C A et al.. Usefulness of pulse deficit to predict in-hospital complications and mortality in patients with acute type A aortic dissection. Am J Cardiol. 2002; 89 851-855
27 Walker P J, Dake M D, Mitchell R S, Miller D C. The use of endovascular techniques for the treatment of complications of aortic dissection. J Vasc Surg. 1993; 18 1042-1051
28 Elefteriades J A, Hartleroad J, Gusberg R J et al.. Long-term experience with descending aortic dissection: the complication-specific approach. Ann Thorac Surg. 1992; 53 11-20 , discussion 20-21
29 Wheat Jr M W. Acute dissection of the aorta. Cardiovasc Clin. 1987; 17 241-262
30 Richter G M, Allenberg J R, Schumacher H, Hansmann J, Vahl C, Hagl S. [Aortic dissection-when operative treatment, when endoluminal therapy?]. Radiologe. 2001; 41 660-667
31 Doroghazi R M, Slater E E, DeSanctis R W, Buckley M J, Austen W G, Rosenthal S. Long-term survival of patients with treated aortic dissection. J Am Coll Cardiol. 1984; 3 1026-1034
32 Sueyoshi E, Sakamoto I, Hayashi K, Yamaguchi T, Imada T. Growth rate of aortic diameter in patients with type B aortic dissection during the chronic phase. Circulation. 2004; 110(suppl 1) II256-II261
33 Sawhney N S, DeMaria A N, Blanchard D G. Aortic intramural hematoma: an increasingly recognized and potentially fatal entity. Chest. 2001; 120 1340-1346
34 Nienaber C A, Richartz B M, Rehders T, Ince H, Petzsch M. Aortic intramural haematoma: natural history and predictive factors for complications. Heart. 2004; 90 372-374
35 Coady M A, Rizzo J A, Hammond G L, Pierce J G, Kopf G S, Elefteriades J A. Penetrating ulcer of the thoracic aorta: what is it? How do we recognize it? How do we manage it?. J Vasc Surg. 1998; 27 1006-1015 , discussion 1015-1016
36 Tittle S L, Lynch R J, Cole P E et al.. Midterm follow-up of penetrating ulcer and intramural hematoma of the aorta. J Thorac Cardiovasc Surg. 2002; 123 1051-1059
37 Slonim S M, Miller D C, Mitchell R S, Semba C P, Razavi M K, Dake M D. Percutaneous balloon fenestration and stenting for life-threatening ischemic complications in patients with acute aortic dissection. J Thorac Cardiovasc Surg. 1999; 117 1118-1126
38 Dake M D, Kato N, Mitchell R S et al.. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med. 1999; 340 1546-1552
39 Nienaber C A, Fattori R, Lund G et al.. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med. 1999; 340 1539-1545
40 Beregi J P, Prat A, Gaxotte V, Delomez M, McFadden E P. Endovascular treatment for dissection of the descending aorta. Lancet. 2000; 356 482-483
41 Kato M, Matsuda T, Kaneko M et al.. Outcomes of stent-graft treatment of false lumen in aortic dissection. Circulation. 1998; 98(suppl) II305-II311 , discussion II311-312
42 Williams D M, Andrews J C, Marx M V, Abrams G D. Creation of reentry tears in aortic dissection by means of percutaneous balloon fenestration: gross anatomic and histologic considerations. J Vasc Interv Radiol. 1993; 4 75-83
43 Bernard Y, Zimmermann H, Chocron S et al.. False lumen patency as a predictor of late outcome in aortic dissection. Am J Cardiol. 2001; 87 1378-1382
44 Hausegger K A, Oberwalder P, Tiesenhausen K et al.. Intentional left subclavian artery occlusion by thoracic aortic stent-grafts without surgical transposition. J Endovasc Ther. 2001; 8 472-476
45 Rehders T C, Petzsch M, Ince H et al.. Intentional occlusion of the left subclavian artery during stent-graft implantation in the thoracic aorta: risk and relevance. J Endovasc Ther. 2004; 11 659-666
46 Williams D M, Lee D Y, Hamilton B H et al.. The dissected aorta: percutaneous treatment of ischemic complications: principles and results. J Vasc Interv Radiol. 1997; 8 605-625
47 Slonim S M, Nyman U, Semba C P, Miller D C, Mitchell R S, Dake M D. Aortic dissection: percutaneous management of ischemic complications with endovascular stents and balloon fenestration. J Vasc Surg. 1996; 23 241-251 , discussion 251-253
48 Chavan A, Hausmann D, Dresler C et al.. Intravascular ultrasound-guided percutaneous fenestration of the intimal flap in the dissected aorta. Circulation. 1997; 96 2124-2127
49 Yunoki K, Uchida H, Sano S, Shimizu N. Effects of endoluminal stent-grafts on acute aortic dissection in dogs. Acta Med Okayama. 1998; 52 89-95
50 Lopera J, Patino J H, Urbina C et al.. Endovascular treatment of complicated type-B aortic dissection with stent-grafts: midterm results. J Vasc Interv Radiol. 2003; 14 195-203
51 Palma J H, de Souza J A, Rodrigues Alves C M, Carvalho A C, Buffolo E. Self-expandable aortic stent-grafts for treatment of descending aortic dissections. Ann Thorac Surg. 2002; 73 1138-1141 , discussion 1141-1142
52 Taylor P R, Bell R E, Reidy J F. Endovascular treatment of acute type B aortic dissection. Acta Chir Belg. 2004; 104 513-518
53 Fann J I, Miller D C. Endovascular treatment of descending thoracic aortic aneurysms and dissections. Surg Clin North Am. 1999; 79 551-574
54 Kato N, Hirano T, Shimono T et al.. Treatment of chronic type B aortic dissection with endovascular stent-graft placement. Cardiovasc Intervent Radiol. 2000; 23 60-62
55 Kato N, Shimono T, Hirano T et al.. Midterm results of stent-graft repair of acute and chronic aortic dissection with descending tear: the complication-specific approach. J Thorac Cardiovasc Surg. 2002; 124 306-312
56 Shimono T, Kato N, Yasuda F et al.. Transluminal stent-graft placements for the treatments of acute onset and chronic aortic dissections. Circulation. 2002; 106(suppl 1) I241-I247
57 Svensson L G, Hess K R, Coselli J S, Safi H J. Influence of segmental arteries, extent, and atriofemoral bypass on postoperative paraplegia after thoracoabdominal aortic operations. J Vasc Surg. 1994; 20 255-262
58 Eggebrecht H, Nienaber C A, Neuhauser M et al.. Endovascular stent-graft placement in aortic dissection: a meta-analysis. Eur Heart J. 2006; 27 489-498
59 Umana J P, Miller D C, Mitchell R S. What is the best treatment for patients with acute type B aortic dissections: medical, surgical, or endovascular stent-grafting?. Ann Thorac Surg. 2002; 74 S1840-S1843 , discussion S1857-S1863
60 Gaxotte V, Thony F, Rousseau H et al.. Midterm results of aortic diameter outcomes after thoracic stent-graft implantation for aortic dissection: a multicenter study. J Endovasc Ther. 2006; 13 127-138
61 Akutsu K, Nejima J, Kiuchi K et al.. Effects of the patent false lumen on the long-term outcome of type B acute aortic dissection. Eur J Cardiothorac Surg. 2004; 26 359-366
62 Nienaber C A, Kische S, Zeller T et al.. Provisional extension to induce complete attachment after stent-graft placement in type B aortic dissection: the PETTICOAT concept. J Endovasc Ther. 2006; 13 738-746
63 Shimono T, Kato N, Tokui T et al.. Endovascular stent-graft repair for acute type A aortic dissection with an intimal tear in the descending aorta. J Thorac Cardiovasc Surg. 1998; 116 171-173
64 Kato N, Shimono T, Hirano T, Ishida M, Yada I, Takeda K. Transluminal placement of endovascular stent-grafts for the treatment of type A aortic dissection with an entry tear in the descending thoracic aorta. J Vasc Surg. 2001; 34 1023-1028
65 Nienaber C A, Zannetti S, Barbieri B et al.. INvestigation of STEnt grafts in patients with type B Aortic Dissection: design of the INSTEAD trial-a prospective, multicenter, European randomized trial. Am Heart J. 2005; 149 592-599
66 Harris K M, Braverman A C, Gutierrez F R, Barzilai B, Davila-Roman V G. Transesophageal echocardiographic and clinical features of aortic intramural hematoma. J Thorac Cardiovasc Surg. 1997; 114 619-626
67 Schoder M, Grabenwoger M, Holzenbein T et al.. Endovascular stent-graft repair of complicated penetrating atherosclerotic ulcers of the descending thoracic aorta. J Vasc Surg. 2002; 36 720-726
68 Kos X, Bouchard L, Otal P et al.. Stent-graft treatment of penetrating thoracic aortic ulcers. J Endovasc Ther. 2002; 9(suppl 2) II25-II31
69 Brittenden J, McBride K, McInnes G, Gillespie I N, Bradbury A W. The use of endovascular stents in the treatment of penetrating ulcers of the thoracic aorta. J Vasc Surg. 1999; 30 946-949
70 Demers P, Miller D C, Mitchell R S, Kee S T, Chagonjian L, Dake M D. Stent-graft repair of penetrating atherosclerotic ulcers in the descending thoracic aorta: mid-term results. Ann Thorac Surg. 2004; 77 81-86
71 Eggebrecht H, Baumgart D, Schmermund A et al.. Penetrating atherosclerotic ulcer of the aorta: treatment by endovascular stent-graft placement. Curr Opin Cardiol. 2003; 18 431-435
72 Chung J W, Elkins C, Sakai T et al.. True-lumen collapse in aortic dissection: part II. Evaluation of treatment methods in phantoms with pulsatile flow. Radiology. 2000; 214 99-106
73 Vedantham S, Picus D, Sanchez L A et al.. Percutaneous management of ischemic complications in patients with type-B aortic dissection. J Vasc Interv Radiol. 2003; 14 181-194

H. RousseauM.D.

Department of Radiology, Hôpital Rangueil, 1, avenue Jean-Poulhes

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