scholarly journals Endovascular Treatment of Isolated Chronic Abdominal Aortic Dissection

2016 ◽  
Vol 29 (3) ◽  
pp. 224
Author(s):  
Rui Machado ◽  
Duarte Rego ◽  
Luís Loureiro ◽  
Rui Almeida
Keyword(s):  
Aortic Dissection ◽  
Endovascular Treatment ◽  
Rare Event ◽  
Endovascular Intervention ◽  
Adequate Treatment ◽  
Initial Surgery ◽  
Abdominal Aortic ◽  
Long Term Follow Up ◽  
Abdominal Aortic Dissection

Isolated acute abdominal aortic dissection is a relatively rare event. Its natural history is not fully understood and its optimal treatment is not established. Open surgery represents the most described treatment but endovascular intervention has had increasing application. Isolated chronic abdominal aortic dissection  is even less described in the literature. We describe three patients with isolated chronic abdominal aortic dissection who underwent endovascular treatment in our institution. Mean age at presentation was 82 years. Indication for surgical intervention was aneurismal degeneration. Mean aortic diameter at presentation was 46.7 mm. There was no perioperative mortality or reinterventions. Mean follow-up was 5.3 years (2-12 years). Late reintervention was needed in one patient, eight years after initial surgery, due to type 1 endoleak. According to our experience, endovascular intervention represents an effective and durable treatment option in isolated chronic abdominal aortic dissection. However, long-term follow-up is mandatory. Furthermore, larger studies are still needed to understand this disease and its adequate treatment.

scholarly journals Endovascular treatment of isolated abdominal aortic dissection and postoperative aortic remodeling

2015 ◽  
Vol 61 (6) ◽  
pp. 1424-1431 ◽  
Author(s):  
Qian-qian Zhu ◽  
Dong-lin Li ◽  
Ming-chun Lai ◽  
Xu-dong Chen ◽  
Wei Jin ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Endovascular Treatment ◽  
Abdominal Aortic ◽  
Abdominal Aortic Dissection ◽  
Aortic Remodeling

scholarly journals Chronic abdominal aortic dissection, endovascular treatment using a new Stent-graft for in situ Fenestration

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Hernan G. Bertoni ◽  
German A. Girela ◽  
Hector D. Barone ◽  
Federico De Caso ◽  
Alejandro De La Vega ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Endovascular Treatment ◽  
Stent Graft ◽  
Covered Stent ◽  
Left Renal Artery ◽  
Abdominal Aortic ◽  
History Of ◽  
Elective Procedure ◽  
Abdominal Aortic Dissection

Abstract Background Although endovascular treatment of the thoracic aorta (TEVAR) has become an elective procedure for treatment of complicated type B aortic dissection, its role in treating post dissection thoraco-abdominal aortic aneurysm (TAAA), is still limited. This is a case of aortic vascular disease, which reports the use of a new endovascular device. Case presentation : We present the case of a 62 year old male patient with a history of hypertension, active smoker, who presented penetrating descending thoracic aortic ulcer in the setting of a chronic abdominal aortic dissection. The patient was treated using a new stent graft capable of in situ fenestration that allowed crossing the stent-graft membrane, implanting a covered stent to exclude the re-entry at the level of the left renal artery and redirecting the blood flow through the true lumen. Conclusions This case report demonstrates the feasibility of a novel stent-graft concept. Larger studies with longer follow-up are essential to fully evaluate the safety and effectiveness of this new design.

Similar Midterm Clinical Outcomes and Aortic Remodeling in Bifurcated and Straight Aortic Stent Grafts Used to Treat Isolated Abdominal Aortic Dissection

2021 ◽  
pp. 152660282110612
Author(s):  
Tun Wang ◽  
Chang Shu ◽  
Quan-ming Li ◽  
Ming Li ◽  
Xin Li ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Type I ◽  
Stent Grafts ◽  
Type A Aortic Dissection ◽  
Abdominal Aortic ◽  
Abdominal Aortic Dissection ◽  
Aortic Remodeling ◽  
Bifurcated Graft

Purpose: The optimal treatment for isolated abdominal aortic dissection (IAAD) is currently unknown. We compared the effects of straight and bifurcated aortic stent grafts on postoperative aortic remodeling in patients with IAAD. Materials and Methods: From February 2012 to December 2019, 57 patients with IAAD were treated using endovascular methods, including either a bifurcated or a straight aortic stent graft. The clinical features, risk factors, computed tomography angiograms, midterm follow-up results, and aortic remodeling of these patients were reviewed and analyzed. Results: In total, 44 (77%) patients were treated with a bifurcated graft and 13 (23%) patients were treated with a straight graft. Patients treated with straight grafts had fewer common iliac arteries involved (38% vs 73%, p=0.023), the dissection length was shorter (76.3 ± 40.0 vs 116.2 ± 56.7 mm, p=0.011), and the preoperative aortic diameter (26.0 ± 5.6 vs 35.2 ± 12.1 mm) and the false lumen diameter (13.1 ± 5.2 vs 21.2 ± 11.3 mm) were smaller. During the procedure, there were 3 (5.3%) type I endoleaks, 1 (1.8%) surgical conversion and 1 (1.8%) partial renal artery coverage without perioperative mortality. Patients with straight grafts had shorter operative time (96.5 ± 24.4 vs 144.2 ± 49.0 minutes, p<0.0001). The median follow-up duration was 37.6 ± 21.0 (range = 3–89) months with 1 (1.8%) aortic-related death. Type A aortic dissection occurred in 1 (1.8%) patient. New descending aortic dissection occurred in 3 (5.3%) patients, and 1 patient advanced to type A aortic dissection 3 months later. Two (3.5%) patients had limb occlusion. There was no significant difference in aortic remodeling, survival, and freedom from all adverse events between the 2 treatment strategies. Conclusions: Endovascular treatment provides a safe, minimally invasive treatment for IAAD in midterm follow-up. Compression of the true lumen at the aortic bifurcation is the main concern after treatment with a bifurcated graft. Straight grafts are an excellent alternative for some patients, with the benefit of reduced procedural time, effective aortic remodeling, and excellent clinical prognosis. More experience is needed to offer clear recommendations for making treatment decisions as well as determine long-term effectiveness and durability.

scholarly journals Endovascular treatment of spontaneous isolated abdominal aortic dissection

2016 ◽  
Vol 5 (12) ◽  
pp. 205846011668104 ◽  
Author(s):  
Anna Maria Giribono ◽  
Doriana Ferrara ◽  
Flavia Spalla ◽  
Donatella Narese ◽  
Umberto Bracale ◽  
...  
Keyword(s):  
Back Pain ◽  
Aortic Dissection ◽  
Endovascular Treatment ◽  
Lower Limb ◽  
Case Series ◽  
Limb Ischemia ◽  
Metal Stents ◽  
Lower Limb Ischemia ◽  
Abdominal Aortic ◽  
Abdominal Aortic Dissection

Isolated abdominal aortic dissection is a rare clinical disease representing only 1.3% of all dissections. There are a few case series reported in the literature. The causes of this pathology can be spontaneous, iatrogenic, or traumatic. Most patients are asymptomatic and symptoms are usually abdominal or back pain, while claudication and lower limb ischemia are rare. Surgical and endovascular treatment are two valid options with acceptable results. We herein describe nine cases of symptomatic spontaneous isolated abdominal aortic dissection, out of which four successfully were treated with an endovascular approach between July 2003 and July 2013. All patients were men, smokers, symptomatic (either abdominal or back pain or lower limb ischemia), with a history of high blood pressure, with a medical history negative for concomitant aneurysmatic dilatation or previous endovascular intervention. Diagnosis of isolated abdominal aortic dissection were established by contrast-enhanced computed tomography angiography (CTA) of the thoracic and abdominal aorta. All nine patients initially underwent medical treatment. In four symptomatic cases, non-responsive to medical therapy, bare-metal stents or stent grafts were successfully positioned. All patients completed a CTA follow-up of at least 12 months, during which they remained symptom-free. Endovascular management of this condition is associated with a high rate of technical success and a low mortality; therefore, it can be considered the treatment of choice when it is feasible.

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