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Endovascular stent-graft placement for complications of acute type B aortic dissection

Eggebrecht, Holgera; Lönn, Larsb; Herold, Ulfc; Breuckmann, Frankc; Leyh, Rainerc; Jakob, Heinz Gc; Erbel, Raimunda

doi: 10.1097/01.hco.0000181481.86025.a6
Diseases of the aorta, pulmonary and peripheral vessels

Purpose of review To review the concepts and current clinical results of endovascular stent-graft placement for acute complicated type B aortic dissection.

Recent findings The optimal treatment for patients with dissections confined to the descending aorta (Stanford type B-AD) remains a matter of debate. Usually, antihypertensive medical therapy with strict blood pressure lowering below 135/80 mm Hg represents the first choice for patients with uncomplicated type B-AD. Patients with acute complicated type B-AD remain a major therapeutic challenge because surgery of the descending aorta is still associated with high morbidity and mortality. In 1999, endovascular stent-graft placement was introduced as a novel, less invasive treatment option for patients with type B aortic dissection. Current indications include acute (contained) aortic rupture, symptomatic ischemic branch vessel involvement, early aortic expansion, or unrelenting pain. So far, few studies on stent-graft placement in patients with acute complicated aortic dissection have been published reporting an early mortality between 0 and ∼20%.

Summary To date, there is limited experience with endovascular stent-graft placement for acute complicated type B aortic dissection demonstrating its feasibility and life-saving potential. The endovascular approach can avoid the major trauma of open surgery and should help to get patients out of the acute life-threatening phase of the disease; however, long-term results are needed to assess the durability of this treatment.

aDepartment of Cardiology, West-German Heart Center Essen, University of Duisburg-Essen, Essen, Germany; bDepartment of Interventional Radiology, Sahlgrenska University Hospital, Göteborg, Sweden; and cDepartment of Cardio-thoracic Surgery West-German Heart Center Essen, University of Duisburg-Essen, Essen, Germany.

Dr Eggebrecht is recipient of a research grant from the University Duisburg-Essen (IFORES 10+2).

Correspondence to Dr Holger Eggebrecht, Department of Cardiology, University of Duisburg-Essen, Hufelandstraße 55, 45122 Essen, Germany

Tel: +49 201 723 4888; fax: +49 201 723 5480; e-mail: holger.eggebrecht@uni-essen.de

© 2005 Lippincott Williams & Wilkins, Inc.