Document Detail


Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement.
MedLine Citation:
PMID:  10332015     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The treatment of thoracic aortic dissection is guided by prognostic and anatomical information. Proximal dissection requires surgery, but the appropriate treatment of distal thoracic aortic dissection has not been determined, because surgery has failed to improve the prognosis. METHODS: We prospectively evaluated the safety and efficacy of elective transluminal endovascular stent-graft insertion in 12 consecutive patients with descending (type B) aortic dissection and compared the results with surgery in 12 matched controls. In all 24 patients, aortic dissection was diagnosed by magnetic resonance angiography. In each group, the dissection involved the aortic arch in 3 patients and the descending thoracic aorta in all 12 patients. With the patient under general anesthesia, either surgical resection was undertaken or a custom-designed endovascular stent-graft was placed by unilateral arteriotomy. RESULTS: Stent-graft placement resulted in no morbidity or mortality, whereas surgery for type B dissection was associated with four deaths (33 percent, P=0.09) and five serious adverse events (42 percent, P=0.04) within 12 months. Transluminal placement of the stent-graft prosthesis was successful in all patients, with no leakage; full expansion of the stents was ensured by balloon inflation at 2 to 3 atm. Sealing of the entry tear was monitored during the procedure by transesophageal ultrasonography and angiography, and thrombosis of the false lumen was confirmed in all 12 patients after a mean of three months by magnetic resonance imaging. There were no deaths or instances of paraplegia, stroke, embolization, side-branch occlusion, or infection in the stent-graft group; nine patients had postimplantation syndrome, with transient elevation of C-reactive protein levels and body temperature plus mild leukocytosis. All the patients who received stent-grafts recovered, as did seven patients who underwent surgery for type B dissection (58 percent) (P=0.04). CONCLUSIONS: These preliminary observations suggest that elective, nonsurgical insertion of an endovascular stent-graft is safe and efficacious in selected patients who have thoracic aortic dissection and for whom surgery is indicated. Endoluminal repair may be useful for interventional reconstruction of thoracic aortic dissection.
Authors:
C A Nienaber; R Fattori; G Lund; C Dieckmann; W Wolf; Y von Kodolitsch; V Nicolas; A Pierangeli
Related Documents :
10543505 - Risk factors for failure of aortic valvuloplasty in aortic insufficiency with ventricul...
6216905 - Irreversible morphological changes contributing to depressed cardiac function after sur...
8152445 - Progression of aortic dilatation and the benefit of long-term beta-adrenergic blockade ...
9240315 - In situ repair of aortobronchial, aortoesophageal, and aortoenteric fistulae with cryop...
1768325 - Non-attendance for appointments in an out-patients' x-ray department.
1699835 - Dextran-70 versus albumin as plasma expanders in cirrhotic patients with tense ascites ...
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article    
Journal Detail:
Title:  The New England journal of medicine     Volume:  340     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  1999 May 
Date Detail:
Created Date:  1999-05-20     Completed Date:  1999-05-20     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1539-45     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, University Hospital Eppendorf, Hamburg, Germany. nienaber@uke.uni-hamburg.de
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aneurysm, Dissecting / classification,  mortality,  surgery,  therapy*
Aortic Aneurysm, Thoracic / mortality,  surgery,  therapy*
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation / adverse effects,  methods
Female
Humans
Male
Middle Aged
Postoperative Complications / prevention & control
Prospective Studies
Stents*
Comments/Corrections
Comment In:
N Engl J Med. 1999 May 20;340(20):1585-6   [PMID:  10332024 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Ultrasound therapy for calcific tendinitis of the shoulder.
Next Document:  Endovascular stent-graft placement for the treatment of acute aortic dissection.