Vascular Intervention

Transcription

1 10 : , 2001 B Vascular Intervention B stent graft S/G primary entry stenting S/G mm 8 1 MOF 1 endoleak % 10 stenting 3 2 S/G 1 1 S/G mm mm S/G mm S/G 40 mm Vascular intervention 10 : , 2001 Endovascular stent graft repair, B,,, Stenting vascular intervention Tel: vascular intervention stent graft S/G primary entry stenting B B

2 10 3 Stent B 1 CT 40 mm 2 ulcer like projection ULP 40 mm S/G S/G 1 Exclusion criteria: landing zone 1.5 cm 1 cm landing zone landing zone 10 access route multiple entries DSA Stanford type A entry Stanford type A Adamkiewicz 3 S/G primary entry stenting 4 S/G S/G S/G 2~4 S/G primary entry mm S/G ± 4.2 mm 6 2 ULP stenting 3 2 SMA 1 stenting 2 1 Fig. 1 A case of an acute type B dissection with rupture, 75 year-old male A preoperative aortogram shows intimal flap, primary entry at distal site of the left subclavian artery, narrowing of the true lumen of the descending aorta and the extravasation of contrast medium. After endovascular stent graft repair, the aortogram shows the disappearance of the extravasation and the expansion of the true lumen. S/G 1 primary entry SMA stenting S/G 2 S/G primary entry stenting mm 36.2 ± 3.3 mm mm S/G 2 entry 1 S/G S/G n = 12, 1 S/G 9 MOF 1 endoleak % S/G n = 11, 17.0 ± 10.3 endoleak 1 endoleak 4 1 8

3 B Fig. 2 A preoperative CT with contrast shows the intimal flap and the pleural effusion that is enhanced by contrast medium One month after endovascular stent graft repair, the pseudolumen of the aorta nearly disappeared. S/G Surgical conversion S/G 1 75 Fig. 1 Fig. 2 Stenting n = 3 1 MOF S/G SMA stenting 2 n = ± mm S/G n = S/G n = % % % A B primary entry S/G S/G entry exclusion entry entry endovascular stent graft repair ESGR 1~5 B 6 ESGR entry 4 ESGR DSA S/G landing zone ESGR ESGR device 9

4 10 3 B S/G B 1 ULP ESGR 40 mm ULP 8 ESGR 7 1 follow up 7,8 ESGR S/G S/G ULP 9 40 mm mm 40 mm ESGR mm CT 3 2 primary entry landing zone ESGR S/G 10 B ESGR B 29 vascular intervention 40 mm Vascular intervention endovascular stent graft repair & stenting 1 :. Medical Practice, 16: , 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., 116: , ,, : endovascular stent grafting., 60: , ,, :., 39: , 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., 340: , Wheat, M. W. Jr.: Current status of medical therapy of acute dissecting aneurysms of the aorta. World J. Surg., 4: , ,, :., 100: , ,, :., 40: , ,, : ULP., 9: 51-55, Inoue, K., Sato, M., Iwase, T. et al.: Clinical endovascular placement of branched graft for type B aortic dissection. J. Thorac. Cardiovasc. Surg., 112: ,

5 B Clinical Results of Treatment for Acute Type B Aortic Dissections Usefulness of Vascular Intervention Chiaki Kondo 1, Takatsugu Shimono 1, Noriyuki Kato 2, Tomoaki Suzuki 1, Hidehito Kawai 1, Uhito Yuasa 1, Koji Onoda 1, Tadanori Hirano 3, Kan Takeda 2 and Isao Yada 1 1 Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine 2 Department of Radiology, Mie University School of Medicine 3 Department of Radiology, Matsusaka Chuo Hospital Key words: Endovascular stent graft repair, Acute type B aortic dissection, Less invasive, Prevention of aneurysm, Stenting We investigated 29 patients who had acute type B aortic dissection between July 1997 and April They consisted of 19 men and 10 women patients with a mean age of 66.1 years (50 to 84 years). The treatments were endovascular stent grafting for closure of a primary intimal tear, stenting for the stenotic branch, and medication. No emergency operation was performed. Results: 12 patients were treated with stent grafts. Among patients who would have required emergency surgery in the past, 4 patients were treated with stent grafts in this time (2 ruptured cases, 1 impending rupture, 1 ischemia of lower extremities). Eight patients were treated for prevention of aneurysm. One patient who had rupture accompanied by mesenteric ischemia died of MOF. One patient with endoleak showed an increase in the size of the false lumen requiring surgical conversion. Thrombosis of the false lumen was seen in 11 (91.6%) of 12 patients including the deceased case. Three patients were underwent stenting for the stenotic branch (2 mesenteric ischemia, 1 renal ischemia). One patient who had mesenteric ischemia died (the same case that died of MOF, mentioned above). The other two patients were cured of the ischemia. Medical therapy was given to 15 patients. In 12 of these 15 patients, the maximum aortic diameter was less than 40 mm; endovascular stent graft repair (ESGR) was not indicated. In 3 other patients, endovascular treatment was considered contraindicated (2 problem of the position of the entry, 1 complication of the arch aneurysm). In 11 of 15 patients, the size of the false lumen was reduced. In 3 patients whose false lumen was patent at the start, the false lumen continued patent without dilatation. In 3 of 15 patients who received medical treatment, but in whom ESGR was not performed for some reason, one patient showed an increase in the false lumen, resulting in death from rupture 22 months after treatment. Conclusions: Vascular intervention is less invasive and is useful treatment for acute type B aortic dissections that have required emergency operation in the past or in which aneurysms expected in the future. Medication is appropriate for the patients whose aortic diameter is less than 40 mm. (Jpn. J. Vasc. Surg., 10 : , 2001) 11