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PubMed2002

Extensive primary repair of the thoracic aorta in Stanford type A acute aortic dissection by means of a synthetic vascular graft with a self-expandable stent.

OBJECTIVES: To minimize any residual false lumen when operating on patients with an acute type A aortic dissection, we tried to perform extensive primary repair of the thoracic aorta with the modified elephant trunk technique. The early and midterm results of these surgical interventions are reported and evaluated. METHODS: Among the acute type A aortic dissections with extensive false lumen encountered since December 1997, 19 consecutive patients, 15 DeBakey type I with the tear in the ascending, transverse, or both aortas, and 4 DeBakey type III-D with the tear located in the descending aorta, underwent insertion of a synthetic graft with a distally anchored stent in the descending thoracic aorta. The interpolation method was used as an introducer combined with total replacement of the aortic arch by using a synthetic branching graft with only a median sternotomy. RESULTS: One patient died, and 18 were discharged after full recovery. Postoperative computed tomographic scans showed that no residual false lumina were present proximal to the diaphragmatic level, and no false lumina were found in 10 patients. Two patients with acute ischemia of the right kidney caused by narrowing of the true lumen, as demonstrated by radiographic computed tomography, improved significantly after surgical intervention with restoration of blood flow in the true lumen. Paraplegia was not observed in any patient. CONCLUSIONS: In emergency operations for an acute type A aortic dissection, the operation is often limited to replacing the ascending aorta because priority is given to saving the patient's life. However, it is possible to perform extensive primary repair of the thoracic aorta with relative safety by interpolating a synthetic graft with a self-expandable stent.

Aged↗
PubMed1990

Thoracic aortic dissection: pitfalls and artifacts in MR imaging.

Results of 53 thoracic magnetic resonance (MR) imaging examinations were reviewed to determine the prevalence and severity of artifacts and pitfalls that may occur in the evaluation of acute aortic dissection. Grade 1 artifacts and pitfalls were mimics of aortic dissection on individual images but could be demonstrated not to represent a dissection when other images from the same sequence were evaluated. Grade 2 artifacts and pitfalls required the use of images from other planes or sequences to distinguish them from a dissection. Grade 3 artifacts and pitfalls could not be distinguished from a dissection without the use of other imaging modalities. Of the 53 cases examined, 34 (64%) had artifacts or pitfalls of grade 1 or higher, 10 (19%) had artifacts or pitfalls of grade 2 or higher, and one case (2%) had grade 3 artifacts or pitfalls. Sixteen cases had more than one artifact or pitfall. Pitfalls and artifacts that mimic aortic dissection occur in a significant percentage of thoracic MR imaging examinations. An awareness of their existence, knowledge of normal anatomy, the use of axial images in all cases with the addition of images in other planes as needed, rotation of phase and frequency gradients as needed, and clinical correlation may avert misinterpretation in nearly all cases.

Aortic Dissection↗
PubMed1991

Fibrin sealant improves surgical results of type A acute aortic dissections.

From January 1984 to July 1990, 63 patients were operated on for type A acute aortic dissection. Forty-two patients (aged 22 to 80 years) had isolated replacement of the ascending aorta with the following techniques: group 1 (n = 10) had replacement of the ascending aorta with an intraluminal sutureless graft, group 2 (n = 14) had a Dacron prosthesis sutured to the aorta, and in group 3 (n = 18) the proximal and distal aortic stumps were glued together and reinforced at the suture sites with fibrin sealant before implantation of the Dacron prosthesis. There were no significant differences between the three groups with respect to age, sex, or preoperative clinical and anatomical data. Three (30%) intraoperative deaths occurred in group 1, 4 (29%) in group 2, and none in group 3. Cross-clamp and extracorporeal circulation time were significantly lower in group 1 when compared with groups 2 and 3. Perioperative blood loss during the first 24 hours was significantly lower in group 3 (372 +/- 155 mL) when compared with group 1 (755 +/- 210 mL; p less than 0.05) or group 2 (1,055 +/- 370 mL; p less than 0.01). Total hospital mortality was 7 (70%) in group 1, 6 (43%) in group 2, and 1 (5.5%) in group 3. All patients were reviewed: one late death occurred in group 2 and none in the other groups. All survivors were in good clinical condition. In conclusion, intraluminal sutureless grafts allowed shorter cross-clamp and extracorporeal circulation time but did not improve surgical results for treatment of type A acute aortic dissections.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed2003

Operative risk factors of type A aortic dissection: analysis of 252 consecutive patients.

OBJECTIVE: We examined operative risk factors for postoperative death after surgery for acute type A aortic dissection. METHODS: Between 1974 and 1999, 252 patients, 163 men and 89 women (mean+/-SD age, 58+/-12 years) underwent surgery for acute type A aortic dissection. Fifty-eight (23.0%) were in cardiogenic shock at time of surgery. Most patients underwent ascending aorta replacement which was combined with aortic valve replacement by means of a composite graft in 30 (11.9%) patients and an isolated aortic valve replacement in 16 (6.3%) patients. RESULTS: The overall operative mortality rate was 25.0% (n=63); 27.0% for patients operated upon with aortic cross-clamping, 23.7% after deep hypotherm circulatory arrest and 23.3% after antegrade selective cerebral perfusion (ASCP) (p=0.73). Multivariate analysis revealed iatrogenic dissection (p=0.0096, odds ratio=5.7), preoperative cardiopulmonary resuscitation (p=0.0095, odds ratio=5.5) and every quarter of an hour longer extracorporeal circulation (p=0.049, odds ratio=1.1) as independent risk factors for operative mortality. Aortic valve replacement or Bentall procedure (p=0.0185, odds ratio=0.3) were protective factors. There were 44 new postoperative strokes: 4.7% in the group operated upon with and 20.1% in the group without ASCP (p=0.01). CONCLUSION: In order to avoid cardiogenic shock and preoperative cardiopulmonary resuscitation, patients with acute type A aortic dissection should be treated promptly. The choice to use an aortic valve prosthesis or Bentall procedure when applicable seems to benefit the postoperative early survival. The risk of new postoperative neurological events might be reduced by avoiding the appliance of an aortic cross-clamp and by using ASCP.

Adolescent↗
PubMed2001

[CT virtual angioscopy in the study of thoracic aortic dissection].

PURPOSE: Virtual endoscopy is a technique in which helical-CT and MR data sets are processed by a special software creating a three-dimensional viewing of the inner surface of hollow viscera that simulates the endoscopic view. We report our 2.5-year experience with virtual intraluminal endoscopy (VIE) in the study of the thoracic aorta in patients with aortic dissection and in patients with normal aorta. MATERIAL AND METHODS: From December 1997 to June 2000, CT angiography (CTA) data sets of the thoracic aorta obtained in a series of 43 patients were retrospectively evaluated. Our series included 23 patients with clinical or radiological suspicion of aortic dissection and 20 patients in whom the study of the thoracic aorta was carried out as a necessary completion of an abdominal aortic disease. CTA data sets were processed with a dedicated software (Navigator); the view point and view direction could be set arbitrarily in the vessel, obtaining an intraluminal endoscopic view of the inner surface of the vessel. Multiple views were obtained and visualised consecutively through a cine-loop technique. The entire thoracic aorta was studied. RESULTS: VIE enabled correct visualisation of the intimal flap in all cases of aortic dissection (=23) and of its origin at the level of the ascending aorta in 16 cases (Stanford A) and in the descending aorta in the remaining 7 patients (Stanford B). In the control group (=20) no signs of intimal flap were identified with the VIE. In all patients with aortic dissection false and true lumen were entirely visualised. VIE allowed the understanding of the relation between false lumen and supraaortic vessels that originated from the true lumen in all cases and were found to be dissected in 6 patients. In 16 cases the dissection included thoracic and abdominal aorta. In some cases the endoscopic view was altered by artifacts related to the selected threshold levels and represented by pierced surface and floating shape artifacts. A correlation with axial and multiplanar (MPR) images allowed the correct interpretation of such artifacts. CONCLUSIONS: According to our experience, virtual endoscopy represents a useful tool in the evaluation of the dissection of the thoracic aorta, allowing a better definition of anatomical details. A correlation with axial images and multiplanar views remains compulsory for a better understanding of VIE findings, which is nevertheless significantly influenced by the operator's experience.

Aortic Dissection↗
PubMed2006

Early and medium-term results of stent-graft treatment of DeBakey type III aortic dissection.

AIM: The safety and effectiveness of transcatheter stent-graft treatment in the early and medium-term postoperative period was assessed in patients with DeBakey type III aortic dissection. METHODS: Transcatheter stent-graft implantation was performed in 37 patients who had aortic dissection with entry sites in the descending thoracic aorta. Entry sites were closed with a stent-graft consisting of a Gianturco Z stent covered with an UBE woven Dacron graft. RESULTS: There were no in-hospital deaths or serious complications after operation. In 5 patients, a new intimal tear developed at the distal end of the stent-graft 8 to 13 months after operation. It was closed by additional stent-graft placement in 2 patients. The rate of thrombosis of the false lumen of the descending thoracic aorta 5 to 10 days, 3 to 6 months, and 12 months after operation was 70%, 80%, and 81%, respectively. As compared with before operation, the short axis of the true lumen increased (1.4+/-0.8 cm before operation, 2.1+/-0.5 cm at 5-10 days, and 2.7+/-0.6 cm at 3-6 months) and that of the false lumen decreased (2.9+/-0.9 cm, 2.3+/-0.9 cm, 1.5+/-1.2 cm), indicating enlargement of the true lumen and shrinkage of the false lumen. The false lumen was completely obliterated within 3-6 months after operation in 6 patients. CONCLUSIONS: Our early postoperative results show that transcatheter stent-graft implantation is a safe and effective procedure for the management of DeBakey Type III aortic dissection. Devices with a minimal risk of causing intimal tears should be developed.

Aortic Dissection↗
PubMed2004

Differences in clinical presentation, management, and outcomes of acute type a aortic dissection in patients with and without previous cardiac surgery.

BACKGROUND: There are less data on the clinical and diagnostic imaging characteristics, management, and outcomes of patients with previous cardiac surgery (PCS) presenting with acute type A aortic dissection (AAD). METHODS AND RESULTS: In 617 patients with AAD, we evaluated the differences in the clinical characteristics, management, and in-hospital outcomes of the cohorts with and without PCS. A history of PCS was present in 100 of 617 patients. Patients with PCS were more likely to be males (P=0.02), older (P=0.014), and to have a history of previous aortic dissection (P<0.001) or aneurysms (P<0.001). In contrast, PCS patients were less likely to have presenting chest pain (P<0.001). Cardiac tamponade was less common in PCS patients (P=0.007). Fewer AAD patients with PCS underwent surgical repair (P=0.001). Hospital mortality was not adversely influenced by PCS (odds ratio [OR], 1.46; 95% confidence interval [CI], 0.81 to 2.63), but a trend for increased death was seen in patients with previous aortic valve replacement (AVR) (OR, 2.31; 95% CI, 0.98 to 5.43). Age 70 years or older, previous AVR, shock, and renal failure identified PCS patients at risk for death. CONCLUSIONS: Our study highlights differences in clinical characteristics, management, and outcomes of AAD patients with PCS. Importantly, PCS, with the exception of previous AVR, does not adversely influence early outcomes of AAD patients, including those undergoing surgical repair. However, because of otherwise dismal outcomes with medical management of AAD, our data indicate that a history of PCS (even that of previous AVR) should not preclude physicians from recommending surgical correction of type A aortic dissection in appropriate patients.

Acute Kidney Injury↗
PubMed1996

[A successful surgical case of a dissecting aortic aneurysm with right-sided aortic arch and right-sided descending aorta].

The patient was a 70-year-old female whose aortogram and chest computer tomogram revealed DeBakey type IIIb dissecting aortic aneurysm in association with right-sided aortic arch, right-sided descending aorta and aberrant left subclavian artery arising from the Kommerell's diverticulum. Because she had cachexy with hoarseness and difficulty in swallowing caused by an aneurysm she received hypotensive therapy until recovery of her general condition before elective operation. The aneurysm was 7 cm in diameter and was replaced with vascular graft. Reconstruction of the aberrant left subclavian artery and closure of the false lumen via right thoracotomy were also performed under partial bypass installed between the right common femoral vein and artery using modified PCPS. Postoperative computer tomogram and aortogram showed properly replaced vascular graft and closure of false lumen. Dissecting aortic aneurysm complicated with a right-sided arch is quite rare. Including our case, 12 cases have been reported in the world and 9 cases were in Japan. This is one of the most successful surgical case for DeBakey type IIIb dissecting aortic aneurysm in association with right-sided aortic arch, right-sided descending aorta and aberrant left subclavian artery arising from the Kommerell's diverticulum.

Aged↗
PubMed1995

[Stanford type A acute aortic dissection involving an aberrant right subclavian artery--a successful operative case].

A 64-year-old woman was admitted with chest (pain) and back pain. We found aortic dissecting area from ascending aorta to aortic arch and thoracic descending aorta by enhanced computed tomography. She was diagnosed Stanford type A acute aortic dissection. Emergent operation was performed on Jan. 20th, 1994. During operation, we found an aberrant right subclavian artery from Jan. 20th, 1994. During operation, we found an aberrant right subclavian artery from descending aorta. Using non-clamping selective cerebral perfusion, we could succeed this operation. As far as we know, this is the first report in Japanese literatures.

Acute Disease↗
PubMed2002

Bypassing a dilemma: intraoperative coronary angiography in acute aortic dissection.

Untreated coronary artery disease may complicate the clinical course of patients with Stanford type A acute aortic dissection. In these patients the role of coronary angiography for the assessment of coronary circulation is controversial and it is considered by some time consuming thus increasing the risk of rupture. We describe a case of acute type A aortic dissection that illustrates our approach to this problem.

Aged↗
PubMed1991

[Diagnosis of acute aortic dissection with transesophageal echocardiography and results of surgical treatment].

Forty-four consecutive patients with acute aortic dissection from April 1987 to April 1990 were diagnosed with the use of transesophageal echocardiography (TEE) and treated at our institute. In 43 of them (98%, type A: 22 cases, type B: 21 cases), diagnosis was accurate and there were no complications. In one patient with type A dissection, the small intimal flap could not be detected. Emergency operations were performed in the patient with type A and ruptured type B. In type A, operated before cardiac arrest, the operative mortality rate was 20% (4/20). In ruptured type B, the operative mortality rate was 50% (2/4). The result of conservative therapy in the patient with nonruptured type B (17 cases) was satisfactory. The investigation by TEE was carried out without difficulty at the bed side and in the operating room as well, giving precise and rapid information and could be a useful diagnostic mean for acute aortic dissection.

Acute Disease↗
PubMed2001

Preoperative risk factors for hospital mortality in acute type A aortic dissection.

BACKGROUND: Acute type A dissection is associated with postoperative complications and a high mortality rate. This study was performed to determine the perioperative risk factors leading to hospital mortality in patients with acute type A aortic dissection. METHODS: One hundred twenty-two patients with acute type A aortic dissection treated surgically within 48 hours after onset were enrolled in this study. Thirty-two perioperative risk factors were used in statistical analysis for prediction of mortality. Risk factors for hospital death were investigated with univariate and multiple logistic regression analysis. RESULTS: The in-hospital mortality rate including operative death was 12.3% (15 of 122 patients) and the actuarial survival rate (including in-hospital death) was 72%+/-6% at 5 years. Univariate analysis revealed 10 risk factors to be statistically significant predictors of hospital death: age, year of operation (1990 to 1995), Marfan syndrome, preoperative ST segment elevation, heart failure from aortic regurgitation, preoperative shock, preoperative coma, long operation time (> 6 hours), long cardiopulmonary bypass time (> 4 hours), and massive blood transfusion (> 20 units) (p < 0.05). Multiple logistic regression analysis confirmed preoperative ST-T segment elevation and massive blood transfusion to be statistically significant independent risk factors for hospital death (p < 0.05). CONCLUSIONS: Preoperative ST-T elevation and massive blood transfusion during operation were identified as significant independent risk factors for hospital mortality after operation for acute type A aortic dissection. Our findings should contribute to estimation of operative risk in individual patients.

Acute Disease↗
PubMed2006

Complications after endovascular repair of acute symptomatic and chronic expanding Stanford type B aortic dissections.

OBJECTIVE: To outline the complications after endovascular repair in patients with acute symptomatic and chronic expanding Stanford type B aortic dissections. METHODS: Between 1997 and 2004, of 125 patients with acute and chronic aortic type B dissections, 88 were treated conservatively. Thirty-seven patients (29 male, mean age 58 years, range 30-82 years) underwent endovascular repair (30%) using 44 stent grafts of 3 different designs: Excluder (W. L. Gore & Associates, Inc, Flagstaff, Ariz), Talent (Medtronic Vascular, Santa Rosa, Calif), and Endofit (Endomed, Inc, Phoenix, Ariz). Indications for treatment were acute symptomatic type B dissection in 15 patients, chronic expanding aortic dissection greater than 55 mm in 14, rupture in 3, and simultaneous type A repair in 5 patients. Twenty-two operations were performed on an emergency basis. Patient characteristics, procedural variables, outcome, and complications were prospectively recorded. All patients underwent follow-up by computed tomography before discharge, at 6 and 12 months, and annually thereafter (mean follow-up: 24 months). RESULTS: Correct deployment was achieved in 97% of cases. There were no instances of primary conversion, paraplegia, or stroke. Complete false lumen thrombosis was observed in 11 patients (44%). Perioperative complication rate was 22%. Thirty-day mortality rate in acute and chronic dissections was 19% and 0%, respectively. Freedom from aortic reintervention was 81%, 73%, and 68%, freedom from late rupture was 97%, 90%, and 80%, and overall success rate was 76%, 65%, and 57% at 1, 2, and 5 years, respectively. Results for patients with chronic dissections are significantly (P = .038) better than results in those with acute dissections. CONCLUSIONS: Despite the minimally invasive approach, the complication and mortality rates for endovascular therapy of aortic dissections are still high. Frank reporting of these sequelae is if great importance to clarify the recent limitations of the method.

Acute Disease↗
PubMed1995

Feasibility, accuracy and safety of magnetic resonance imaging in acute aortic dissection.

Magnetic resonance imaging (MRI) is the most accurate method of defining the morphology and haemodynamic features of thoracic aortic dissection. However, because of doubts about its safety in acute situations, its use has so far been confined to imaging chronic dissections. We present a prospective study of 50 patients thought clinically to have acute thoracic aortic dissection in which a rapid diagnosis was made by MRI.

Acute Disease↗
PubMed1991

[Dissecting aortic aneurysm associated with myonephropathic-metabolic syndrome and hypercalcemia].

A forty-two years old male underwent an aortic arch replacement for an emergency treatment of dissecting aortic aneurysm (DeBakey type I). Separate cardiopulmonary bypass was used with main arterial inflow cannula inserted to right femoral artery. After the operation, ischemia of the right lower extremity led to acute renal failure due to myonephropathic-metabolic syndrome. Peritoneal dialysis, hemodialysis, and continuous arterio-venous hemofiltration were performed. Renal failure improved gradually. At the diuretic phase serum calcium concentration began to rise. Inspite of large amount of fluid and furosemide injection it became higher and finally reached to 20 mg/dl level. Calcitonin injection (320 mu/day) was very effective. In 2 months after surgery serum creatinine and calcium concentrations went down to normal range. Abnormalities in calcium metabolism are frequent in rhabdomyolysis-induced acute renal failure. However, it is rare to encounter such a remarkable hypercalcemia as seen in this patient. When treating MNMS we should pay attention to the changes of serum calcium concentration.

Acute Kidney Injury↗
PubMed1995

[A case report of closing aortic dissection with cardiac tamponade which developed re-dissection three weeks later].

A 57-year-old female with hypotension and consciousness disturbance was referred to our institute. Echocardiography and plain CT revealed cardiac tamponade, but no apparent evidence of aortic dissection was obtained. With sudden onset of hypotension, she was immediately operated without information of aortography, enhanced CT, and MRI. Approximately 200 g of pericardial hemorrhage and slight subadventitial hematoma was grossly found and surface ultrasonography revealed the mild localized intramural hematoma (crescent-shaped translucent layer of at most 5 mm in width) at the proximal ascending aorta. Because neither false lumen with blood flow nor intimal flap was found, pericardial drainage without aortic replacement was performed. However, DeBakey type II of aortic dissection with wide false lumen was found with CT and MRI within three weeks, and re-operation was carried out. The dissection ranged from the ostium of right coronary artery to the beginning of innominate artery, but did not involve the coronary arteries and major branches of aortic arch. The surface ultrasonography and transesophageal echocardiography, as well as preoperative CT and MRI, demonstrated that false lumen was thrombosed except at the anterior aspect of mid-portion of ascending aorta. The ascending aorta was replaced. A careful follow-up is mandatory for even a localized intramural hematoma, which can progress into aortic dissection in a short period.

Aortic Dissection↗
PubMed2000

Surgery for acute type a aortic dissection: comparison of techniques.

OBJECTIVE: In order to determine the optimal surgical strategy for acute ascending aortic dissection, the graft inclusion technique was compared with the open resection technique. METHODS: Between 1985 and 1995 a consecutive series of 193 patients (77% male, mean age 58 years) had emergency surgery during a mean interval of 13.2 h after onset of symptoms. Graft replacement of the ascending aorta was performed in all patients (supracoronary graft 143/193=74%, aortic root replacement 50/193=26%, aortic valve replacement 73/193=38%, arch replacement 44/193=20%) The open resection technique was applied in 93 patients and the inclusion technique in 100 patients with a Cabrol-shunt in 26%. Preoperative risk factors were equally distributed between groups (inclusion technique vs. open technique): left ventricular ejection fraction<45% (13 vs. 2%, not significant (n.s.)), neurological deficit (31 vs. 25%; n.s.), systolic blood pressure<90 mm Hg (20 vs. 15%, n.s.) pericardial tamponade (25 vs. 9%, n.s.), renal failure (6 vs. 4%; n.s.). RESULTS: The overall early mortality was 24%. Following graft inclusion it was 31% compared with 16% in the open technique group (P=0.0154). Postoperative complications (graft inclusion vs. open technique): myocardial infarction (9 vs. 12%, n.s.), low cardiac output (40 vs. 32%, n.s.), reexploration for hemorrhage (23 vs. 25%, n.s.). Survival at 8 years was significantly increased in the open technique group (P=0.0300). Pseudoaneurysm formation occurred in 3% of patients and only after graft inclusion. Freedom from reoperation was 80% at 8 years and did not differ between groups. Graft inclusion was an independent significant predictor of early (P=0.0069; relative risk=2.3673) and late mortality (P=0.0119; relative risk=2.0981). CONCLUSIONS: Surgery of acute ascending aortic dissection still carries a considerable early mortality whereas the late outcome is satisfactory. The open resection technique is the method of choice showing superior early and late results and avoiding pseudoaneurysm formation. The inclusion technique may be indicated in situations with increased risk of bleeding. A consequent decompression of the perigraft-space could reduce the rate of pseudoaneurysms.

Acute Disease↗
PubMed2002

Endoluminal stent-graft placement in patients with acute aortic dissection type B.

OBJECTIVES: This study was performed to evaluate the feasibility, safety and effectiveness of endovascular stent-grafting in treating Stanford type B acute aortic dissection. We describe our first clinical experiences and initial results with stent-grafting across the primary entry tear in patients with acute aortic dissection type B. METHODS: Between March 2000 and August 2001, nine patients with acute type B dissection were treated endoluminally by stent-graft implantation. There were seven male and two female patients with a mean age of 63 years (between 48 and 85 years). In all nine patients aortic dissection was diagnosed by multislice computed tomography (CT) angiography. All nine patients had a maximal aortic diameter of 5.5 cm or more and recurrent pain, one patient showed hemoptysis. This patient with signs of a contained rupture was treated under emergency condition, the eight remaining patients were in hemodynamic stabile condition at the time of intervention. The GORE Excluder stent-graft system was used in eight patients (mean 1.8 stents/patient) and the TALENT stent-graft system in one patient, which were introduced transfemorally. RESULTS: The primary entry tear could be sealed successfully in all nine patients. Complete thrombosis of the false thoracic aortic lumen was obtained in two patients, in the remaining seven patients the false lumen was obliterated in the area of the thoracic aorta but perfused via re-entries in the abdominal region. No severe intraoperative complications occurred. One patient developed bilateral incomplete paraplegia with motor and sensory deficits affecting completely the right leg and partially the left leg, 14 h after intervention. A cerebrospinal fluid drainage was initiated by inserting a lumbar catheter. All nine patients, including the patient with the transient paraplegia, could be discharged from the hospital in excellent condition and without remaining neurologic deficits. Control CT scans showed a reduction of the false lumen from 2.34+/-0.58 to 0.7+/-0.44 cm and an increase of the true lumen from 1.56+/-0.5 to 4.10+/-0.6 cm in the thoracic aortic region. Mean ICU stay was 1.8 days, mean postoperative hospital stay was 7.6 days. CONCLUSIONS: Stent-grafting of acute type B dissections may represent a very effective and promising new method by closure of the primary entry tear, thereby minimizing the risk of rupture of the thoracic aorta and optimizing distal perfusion by decompression of the true lumen.

Aged↗