A Feasibility Study of Off-the-Shelf Scalloped Stent-Grafts in Acute Type B Aortic Dissection
Articolo
Data di Pubblicazione:
2017
Citazione:
A Feasibility Study of Off-the-Shelf Scalloped Stent-Grafts in Acute Type B Aortic Dissection / E. van der Weijde, O.J. Bakker, A.V. Kamman, J.A. van Herwaarden, S. Trimarchi, J.A. Vos, R.H. Heijmen. - In: JOURNAL OF ENDOVASCULAR THERAPY. - ISSN 1526-6028. - 24:6(2017 Dec), pp. 819-824. [10.1177/1526602817726329]
Abstract:
Purpose: To evaluate the applicability of an off-the-shelf scalloped stent-graft to preserve left subclavian artery (LSA) flow in thoracic endovascular aortic repair (TEVAR) for acute type B aortic dissection. Methods: The computed tomography angiograms (CTA) of 70 consecutive patients (median age 64 years; 44 men) with acute Stanford type B aortic dissection were retrospectively analyzed to identify patients in whom a short proximal landing zone (<15 mm from the retrogradely dissected wall layers) would require LSA overstenting during TEVAR. A scalloped stent-graft was deemed possible in those patients with the intimal entry tear located at least 20 mm distant from the LSA ostium. Results: The LSA needed to be covered in 56 (80%) patients. Of these, an off-the-shelf scalloped stent-graft would have been applicable in 23 (41%) patients. In the latter group, the median aortic diameter was 31 mm (range 26-37), the median length of the LSA ostium was 13 mm (range 10-20), and the median width of the LSA ostium was 15 mm (range 11-24). Three differently sized off-the-shelf stent-grafts with the largest scallop possible could have adequately treated 20 (36%) of the 56 patients in the acute phase. Conclusion: In this single-center imaging-based study, involvement of the LSA in the setting of acute type B aortic dissection was seen in 80% of patients treated with TEVAR. Three off-the-shelf stent-grafts would suffice to treat one-third of these acute type B aortic dissections and may offer a relatively simple solution to preserve LSA flow, thereby lowering the risk of malperfusion of the (posterior) cerebrum, spinal cord, and left arm in an urgent/emergent setting.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
computed tomography angiography; feasibility study; left subclavian artery; off-the-shelf stent-graft; proximal landing zone; scallop; thoracic endovascular aortic repair; type B aortic dissection
Elenco autori:
E. van der Weijde, O.J. Bakker, A.V. Kamman, J.A. van Herwaarden, S. Trimarchi, J.A. Vos, R.H. Heijmen
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