Semin intervent Radiol 2007; 24(2): 167-179
DOI: 10.1055/s-2007-980041
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

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
Further Information

Publication History

Publication Date:
12 June 2007 (online)

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.

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

TSA 50 032, 31059, Toulouse cedex 9, France

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