Complicated Acute Type B Dissections: A Single-Center Experience with Endovascular Treatment

Background: Complicated acute type B dissections treated surgically carry a high risk of mortality. Endovascular interventions with stent-graft prostheses are a less invasive alternative and may obviate the need for surgery in most cases. We report here on our five years' experience with endovascular stenting in complicated acute type B dissections. Patients and Methods: Between March 2001 and January 2006, 32 patients (27 males, 5 females) with a mean age of 61.4 +/- 11.32 years (range 29-80) underwent stent grafting for complicated acute type B dissections. Indications were progression of dissection with impending rupture (n = 10), uncontrollable hypertension (n = 9), in-tractable thoracic pain (n = 7), and malperfusion syndrome (n = 6). Talent (TM)-Medtronic (n = 34) and Excluder (TM)-Gore (n = 3) stent-grafts were used. In 5 patients two stents were necessary. In addition to stent grafting, aortic fenestration was performed in all three cases with lower limb ischemia. Results: Endovascular stent placement was successful in all patients. Hospital mortality was 9.3% (3/32). No deaths occurred during follow-up (mean 32 months). Conclusion: Endovascular stenting of complicated acute type B dissections represents a safe alternative to surgery. Endovascular stent-grafts of appropriate sizes should be readily available in the hospital for emergency use, thus avoiding delays in treatment.