Controlled balloon false lumen obliteration for the endovascular management of chronic dissection in the descending thoracic aortaCentral MessagePerspective
Objective: Retrograde false lumen perfusion has limited the utility of aortic stent grafting for chronic aortic dissection. It is unknown whether balloon septal rupture can improve the outcomes for endovascular management of chronic aortic dissection. Methods: Included patients underwent false lumen...
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Elsevier
2023-06-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250723000378 |
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| author | A. Claire Watkins, MD, MS Shernaz Dossabhoy, MD Alex R. Dalal, MD Aleena Yasin, MD Matthew Leipzig, BS Benjamin Colvard, MD Jason T. Lee, MD Michael D. Dake, MD |
| author_facet | A. Claire Watkins, MD, MS Shernaz Dossabhoy, MD Alex R. Dalal, MD Aleena Yasin, MD Matthew Leipzig, BS Benjamin Colvard, MD Jason T. Lee, MD Michael D. Dake, MD |
| author_sort | A. Claire Watkins, MD, MS |
| collection | DOAJ |
| description | Objective: Retrograde false lumen perfusion has limited the utility of aortic stent grafting for chronic aortic dissection. It is unknown whether balloon septal rupture can improve the outcomes for endovascular management of chronic aortic dissection. Methods: Included patients underwent false lumen obliteration and creation of a single-lumen aortic landing zone using balloon aortoplasty during thoracic endovascular aortic repair. The distal thoracic stent graft was sized to the total aortic lumen diameter, and septal rupture was performed within the stent graft with a compliant balloon in the region 5 cm proximal to the distal fabric edge. Clinical and radiographic outcomes are reported. Results: Forty patients, with an average age 56 years, underwent thoracic endovascular aortic repair with septal rupture. Seventeen patients (43%) had chronic type B dissections, 17 of 40 patients (43%) had residual type A dissections, and 6 of 40 patients (15%) had acute type B dissections. Nine cases were emergency, complicated by rupture or malperfusion. Perioperative complications included 1 death (2.5%) due to rupture of the descending thoracic aorta and 2 (5%) instances each of stroke (neither permanent) and spinal cord ischemia (1 permanent). Two (5%) stent graft–induced new injuries were seen. Average postoperative computed tomography follow-up was 1.4 years. Thirteen patients (33%) had a decrease in aortic size, 25 of 39 patients (64%) were stable, and 1 of 39 patients (2.6%) had an increased aortic size. Partial and complete false lumen thrombosis were achieved in 10 of 39 patients (26%) and 29 of 39 patients (74%), respectively. Midterm aortic-related survival was 97.5% at an average of 1.6 years. Conclusions: Controlled balloon septal rupture offers an effective endovascular method to treat aortic dissection in the distal thoracic aorta. |
| format | Article |
| id | doaj-art-9136452ec5f141d79f4e163bf561b943 |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2023-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-9136452ec5f141d79f4e163bf561b9432025-08-20T03:36:42ZengElsevierJTCVS Techniques2666-25072023-06-01191910.1016/j.xjtc.2023.01.010Controlled balloon false lumen obliteration for the endovascular management of chronic dissection in the descending thoracic aortaCentral MessagePerspectiveA. Claire Watkins, MD, MS0Shernaz Dossabhoy, MD1Alex R. Dalal, MD2Aleena Yasin, MD3Matthew Leipzig, BS4Benjamin Colvard, MD5Jason T. Lee, MD6Michael D. Dake, MD7Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif; Address for reprints: A. Claire Watkins, MD, MS, Department of Cardiothoracic Surgery, Stanford University, Falk Building, 300 Pasteur Dr, Stanford, CA 94305.Division of Vascular Surgery, Stanford University, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University, Stanford, CalifDepartment of Cardiothoracic Surgery, Stanford University, Stanford, CalifDivision of Vascular Surgery and Endovascular Therapy, University Hospitals Cleveland Medical Center, Cleveland, OhioDivision of Vascular Surgery, Stanford University, Stanford, CalifUniversity of Arizona Health Sciences, Tucson, ArizObjective: Retrograde false lumen perfusion has limited the utility of aortic stent grafting for chronic aortic dissection. It is unknown whether balloon septal rupture can improve the outcomes for endovascular management of chronic aortic dissection. Methods: Included patients underwent false lumen obliteration and creation of a single-lumen aortic landing zone using balloon aortoplasty during thoracic endovascular aortic repair. The distal thoracic stent graft was sized to the total aortic lumen diameter, and septal rupture was performed within the stent graft with a compliant balloon in the region 5 cm proximal to the distal fabric edge. Clinical and radiographic outcomes are reported. Results: Forty patients, with an average age 56 years, underwent thoracic endovascular aortic repair with septal rupture. Seventeen patients (43%) had chronic type B dissections, 17 of 40 patients (43%) had residual type A dissections, and 6 of 40 patients (15%) had acute type B dissections. Nine cases were emergency, complicated by rupture or malperfusion. Perioperative complications included 1 death (2.5%) due to rupture of the descending thoracic aorta and 2 (5%) instances each of stroke (neither permanent) and spinal cord ischemia (1 permanent). Two (5%) stent graft–induced new injuries were seen. Average postoperative computed tomography follow-up was 1.4 years. Thirteen patients (33%) had a decrease in aortic size, 25 of 39 patients (64%) were stable, and 1 of 39 patients (2.6%) had an increased aortic size. Partial and complete false lumen thrombosis were achieved in 10 of 39 patients (26%) and 29 of 39 patients (74%), respectively. Midterm aortic-related survival was 97.5% at an average of 1.6 years. Conclusions: Controlled balloon septal rupture offers an effective endovascular method to treat aortic dissection in the distal thoracic aorta.http://www.sciencedirect.com/science/article/pii/S2666250723000378Aortic dissectionStent graftingThoracic endovascular aortic repair |
| spellingShingle | A. Claire Watkins, MD, MS Shernaz Dossabhoy, MD Alex R. Dalal, MD Aleena Yasin, MD Matthew Leipzig, BS Benjamin Colvard, MD Jason T. Lee, MD Michael D. Dake, MD Controlled balloon false lumen obliteration for the endovascular management of chronic dissection in the descending thoracic aortaCentral MessagePerspective JTCVS Techniques Aortic dissection Stent grafting Thoracic endovascular aortic repair |
| title | Controlled balloon false lumen obliteration for the endovascular management of chronic dissection in the descending thoracic aortaCentral MessagePerspective |
| title_full | Controlled balloon false lumen obliteration for the endovascular management of chronic dissection in the descending thoracic aortaCentral MessagePerspective |
| title_fullStr | Controlled balloon false lumen obliteration for the endovascular management of chronic dissection in the descending thoracic aortaCentral MessagePerspective |
| title_full_unstemmed | Controlled balloon false lumen obliteration for the endovascular management of chronic dissection in the descending thoracic aortaCentral MessagePerspective |
| title_short | Controlled balloon false lumen obliteration for the endovascular management of chronic dissection in the descending thoracic aortaCentral MessagePerspective |
| title_sort | controlled balloon false lumen obliteration for the endovascular management of chronic dissection in the descending thoracic aortacentral messageperspective |
| topic | Aortic dissection Stent grafting Thoracic endovascular aortic repair |
| url | http://www.sciencedirect.com/science/article/pii/S2666250723000378 |
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