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Clinical Experience of Endovascular Stent-graft Treatment for Stanford Type A Acute Aortic Dissection Tetsuro Uchida 1 , Yoshinori Kuroda 1 , Atsushi Yamashita 1 , Azumi Hamasaki 1 , Shuto Hirooka 1 , Shingo Nakai 1 , Kimihiro Kobayashi 1 , Mitsuaki Sadahiro 1 1Second Department of Surgery, Yamagata University Keyword: Stanford type A acute aortic dissection , thoracic endovascular aortic repair(TEVAR) pp.976-983
Published Date 2019/11/1
DOI https://doi.org/10.15106/j_kyobu72_976
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Backgrounds:Recently, thoracic endovascular aortic repair (TEVAR) is widely accepted and performed in patients with complicated and uncomplicated Stanford type B aortic dissection. However, TEVAR for Stanford type A aortic dissection is not commonly performed even in the endovascular era. This report describes patients who underwent TEVAR for Stanford type A dissection.

Patients:Since 2016, 5 patients underwent TEVAR for retrograde acute Stanford type A dissection. A covered stent-graft was placed in the descending aorta for primary entry coverage. An additional bare-stent was placed in the narrowed true lumen of the downstream aorta. A thrombosed false lumen was observed in 4 and a partially thrombosed lumen in 1 patient. No patient showed pericardial effusion, aortic insufficiency, or persistent back pain. Four of 5 patients were asymptomatic, and only 1 patient developed multiorgan malperfusion. Repetitive computed tomography (CT) was performed postoperatively.

Results:All patients underwent successful TEVAR without the need for additional intervention, and no operative mortality and morbidity were observed. The patient with multiorgan malperfusion recovered uneventfully without any complication. Follow-up CT revealed complete disappearance of the false lumen in the ascending aorta in all patients.

Conclusions:Although TEVAR of the descending aorta was performed with acceptable mortality and morbidity rates in strictly selected patients with retrograde Stanford type A dissection, conceptual and technical issues remain unresolved in patients with ascending aortic stent-graft placement. Technological advances would lead to the development of innovative disease-specific endovascular devices and solutions in the future for TEVAR in patients with Stanford type A dissection.


© Nankodo Co., Ltd., 2019

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電子版ISSN 2432-9436 印刷版ISSN 0021-5252 南江堂

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