PubMed · 8065428
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M Jakob, D R Spahn, R Jenni. 1994-09-22. Aortic dissection.. https://doi.org/10.1056/nejm199409223311219
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The aortic dissection is an expanding intramural hematoma in the aortic wall separating its layers. That is the most common catastrophic condition of the aorta. Its incidence in Hungary about 3.0%/000/year may be appreciated. The mortality rate of the untreated cases exceeds the 90 per cent. The dissection begins by an intimal tear or by a medial hemorrhage, seldom. The progressing hematoma results in a false lumen running parallel with the true aortic lumen. On the basis of the location of the primary intimal tear the dissection may be proximal or distal. The inherited or acquired medial weakness and the hypertension are the main etiologic factors. Some pathological findings refer to predisposing role of the atherosclerosis. The ischemia caused by the dissection may damage any organ. The clinical picture is characterized by the polymorphism and the migration of the clinical signs. The suspicion of the disease may be raised on the basis of the anamnesis and the clinical picture. The diagnosis may be confirmed by the rutin chest roentgenograms and by the angiography, CT, MRI and ultrasonic examinations. The transoesophageal echocardiography is the best diagnostic tool. The treatment is medical and/or surgical. Advances in the surgical treatment brought turn in the very poor prognosis.
We describe the management of residual dissection protruding through the struts of a Wiktor stent (Medtronic Inc., Minneapolis, MN) implanted in bailout conditions. In general, negotiating a stent through an expanded Wiktor stent is not recommended, but using this strategy, an AVE (Advanced Vascular Engineering, Santa Clara, CA) Micro stent was successfully implanted inside the Wiktor stent, leading to an excellent final angiographic result.