Fate of the False Lumen After Combined Surgical and Endovascular Repair Treating Stanford Type A Aortic Dissections

• Published in: The Annals of thoracic surgery Vol. 89; no. 3; pp. 794 - 799
• Main Authors: Gorlitzer, Michael, MD, Weiss, Gabriel, MD, Meinhart, Johann, PhD, Waldenberger, Ferdinand, MD, Thalmann, Markus, MD, Folkmann, Sandra, MD, Moidl, Reinhard, MD, Grabenwoeger, Martin, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-03-2010; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aneurysm, Dissecting - diagnostic imaging; Aneurysm, Dissecting - surgery; Aorta, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - surgery; Biological and medical sciences; Blood Vessel Prosthesis Implantation; Cardiology. Vascular system; Cardiothoracic Surgery; Female; Humans; Male; Medical sciences; Middle Aged; Pneumology; Stents; Surgery; Tomography, X-Ray Computed; 26; Dissecting aneurysm; Corrective surgery; Treatment; Anesthesia; Aorta; Endovascular route; Circulatory system; Cardiology; Repair
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2009.11.054

Background The purpose of this study was to evaluate the alterations of the aorta by using a new combined surgical and endovascular technique for the treatment of aortic type A dissections. The diameter of the descending aorta, the implanted stent graft, and the false lumen were evaluated. Methods Between August 2005 and February 2009, 14 patients (aged 49 ± 13 years; 11 men, 3 women) with type A dissection in the aorta were operated on the thoracic aorta by the frozen elephant trunk technique. The size dynamics of the false lumen were analyzed by deducting the diameter of the stent graft obtained on computed tomography from the maximum dimension of the aorta. Results The technical success rate was 100%. All patients survived during the follow-up period. The mean follow-up period was 21.4 months. No redisection or aortic rupture occurred during the follow-up period. Postoperative computed tomography scans showed complete thrombus formation of the false lumen in the perigraft space within the entire zone of the stented segment of the hybrid prosthesis during the first 2 weeks after surgery in 12 patients (86%), whereas all patients showed complete obliteration of the false lumen at the 3-month control. The follow-up computed tomography scan obtained after 12 months revealed shrinkage of the false lumen in 9 patients (64%). Conclusions The combined surgical and endovascular technique described in this report proved effective for the treatment of extended aortic lesions. The perigraft space thrombosed completely and had shrunken after successful placement of the stent graft.