Seminars in Thoracic and Cardiovascular Surgery
Volume 21, Issue 4 , Pages 373-386 , Winter 2009

Acute Complicated and Uncomplicated Type III Aortic Dissection: An Endovascular Perspective

  • Castigliano M. Bhamidipati, DO
  • ,
  • Gorav Ailawadi, MD

      Affiliations

    • Corresponding Author InformationAddress reprint requests to Gorav Ailawadi, MD, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, PO Box 800679, Charlottesville, VA 22908

References 

  1. Shekelton J. Healed dissecting aneurysm. Dublin Hosp Rep. 1922;3:231–232
  2. Laennec T. Traite de l'Auscultation Mediate. (ed 2). Paris, France: Chaude; 1826;
  3. Debakey ME, Henly WS, Cooley DA, et al. Surgical management of dissecting aneurysms of the aorta. J Thorac Cardiovasc Surg. 1965;49:130–149
  4. Daily PO, Trueblood HW, Stinson EB, et al. Management of acute aortic dissections. Ann Thorac Surg. 1970;10:237–247
  5. Tran TP, Khoynezhad A. Current management of type B aortic dissection. Vasc Health Risk Manag. 2009;5:53–63
  6. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): New insights into an old disease. JAMA. 2000;283:897–903
  7. Kasirajan K. Commentary on “Complicated acute type B dissection and endovascular repair: Indications and pitfalls.”. Perspect Vasc Surg Endovasc Ther. 2007;19:160–161
  8. Meszaros I, Morocz J, Szlavi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest. 2000;117:1271–1278
  9. Clouse WD, Hallett JW, Schaff HV, et al. Acute aortic dissection: Population-based incidence compared with degenerative aortic aneurysm rupture. Mayo Clin Proc. 2004;79:176–180
  10. Kobza R, Ritter M, Seifert B, et al. Variable seasonal peaks for different types of aortic dissection?. Heart. 2002;88:640
  11. Wheat MW. Acute dissection of the aorta. Cardiovasc Clin. 1987;17:241–262
  12. Subramanian S, Roselli EE. Thoracic aortic dissection: Long-term results of endovascular and open repair. Semin Vasc Surg. 2009;22:61–68
  13. Guilmet D, Bachet J, Goudot B, et al. Aortic dissection: Anatomic types and surgical approaches. J Cardiovasc Surg (Torino). 1993;34:23–32
  14. Lee DY, Williams DM, Abrams GD. The dissected aorta (Part II. Differentiation of the true from the false lumen with intravascular US). Radiology. 1997;203:32–36
  15. Williams DM, Lee DY, Hamilton BH, et al. The dissected aorta (Part III. Anatomy and radiologic diagnosis of branch-vessel compromise). Radiology. 1997;203:37–44
  16. Williams DM, LePage MA, Lee DY. The dissected aorta (Part I. Early anatomic changes in an in vitro model). Radiology. 1997;203:23–31
  17. Patel PD, Arora RR. Pathophysiology, diagnosis, and management of aortic dissection. Ther Adv Cardiovasc Dis. 2008;2:439–468
  18. Ramanath VS, Oh JK, Sundt TM, et al. Acute aortic syndromes and thoracic aortic aneurysm. Mayo Clin Proc. 2009;84:465–481
  19. Cambria RP. Surgical treatment of complicated distal aortic dissection. Semin Vasc Surg. 2002;15:97–107
  20. Cambria RP, Brewster DC, Gertler J, et al. Vascular complications associated with spontaneous aortic dissection. J Vasc Surg. 1988;7:199–209
  21. Katz D, Payne D, Pauker S. Early surgery versus conservative management of dissecting aneurysms of the descending thoracic aorta. Med Decis Making. 2000;20:377–393
  22. Akin I, Kische S, Ince H, et al. Indication, timing and results of endovascular treatment of type B dissection. Eur J Vasc Endovasc Surg. 2009;37:289–296
  23. Onitsuka S, Akashi H, Tayama K, et al. Long-term outcome and prognostic predictors of medically treated acute type B aortic dissections. Ann Thorac Surg. 2004;78:1268–1273
  24. Marui A, Mochizuki T, Koyama T, et al. Degree of fusiform dilatation of the proximal descending aorta in type B acute aortic dissection can predict late aortic events. J Thorac Cardiovasc Surg. 2007;134:1163–1170
  25. Song JM, Kim SD, Kim JH, et al. Long-term predictors of descending aorta aneurysmal change in patients with aortic dissection. J Am Coll Cardiol. 2007;50:799–804
  26. Moore AG, Eagle KA, Bruckman D, et al. Choice of computed tomography, transesophageal echocardiography, magnetic resonance imaging, and aortography in acute aortic dissection: International Registry of Acute Aortic Dissection (IRAD). Am J Cardiol. 2002;89:1235–1238
  27. Shiga T, Wajima Z, Apfel CC, et al. Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: Systematic review and meta-analysis. Arch Intern Med. 2006;166:1350–1356
  28. LePage MA, Quint LE, Sonnad SS, et al. Aortic dissection: CT features that distinguish true lumen from false lumen. Am J Roentgenol. 2001;177:207–211
  29. Khoynezhad A, Donayre CE, Omari BO, et al. Midterm results of endovascular treatment of complicated acute type B aortic dissection. J Thorac Cardiovasc Surg. 2009;138:625–631
  30. Glower DD, Fann JI, Speier RH, et al. Comparison of medical and surgical therapy for uncomplicated descending aortic dissection. Circulation. 1990;82(suppl 5):IV39–IV4682
  31. Fradet G, Jamieson WR, Janusz MT, et al. Aortic dissection: Current expectations and treatment. Experience with 258 patients over 20 years. Can J Surg. 1990;33:465–469
  32. Masuda Y, Yamada Z, Morooka N, et al. Prognosis of patients with medically treated aortic dissections. Circulation. 1991;84(suppl 5):III7–III13
  33. Neya K, Omoto R, Kyo S, et al. Outcome of Stanford type B acute aortic dissection. Circulation. 1992;86(suppl 5):II1–II7
  34. Schor JS, Yerlioglu ME, Galla JD, et al. Selective management of acute type B aortic dissection: Long-term follow-up. Ann Thorac Surg. 1996;61:1339–1341
  35. Gysi J, Schaffner T, Mohacsi P, et al. Early and late outcome of operated and non-operated acute dissection of the descending aorta. Eur J Cardiothorac Surg. 1997;11:1163–1169discussion 1169-1170
  36. Iguchi A, Tabayashi K. Outcome of medically treated Stanford type B aortic dissection. Jpn Circ J. 1998;62:102–105
  37. Elefteriades JA, Lovoulos CJ, Coady MA, et al. Management of descending aortic dissection. Ann Thorac Surg. 1999;67:2002–2005discussion 2014-2019
  38. Marui A, Mochizuki T, Mitsui N, et al. Toward the best treatment for uncomplicated patients with type B acute aortic dissection: A consideration for sound surgical indication. Circulation. 1999;100(suppl 19):II275–II280
  39. Genoni M, Paul M, Tavakoli R, et al. Predictors of complications in acute type B aortic dissection. Eur J Cardiothorac Surg. 2002;22:59–63
  40. Umana JP, Miller DC, Mitchell RS. What is the best treatment for patients with acute type B aortic dissections—Medical, surgical, or endovascular stent-grafting?. Ann Thorac Surg. 2002;74:S1840–S1843discussion S1857-S1863
  41. Hata M, Shiono M, Inoue T, et al. Optimal treatment of type B acute aortic dissection: Long-term medical follow-up results. Ann Thorac Surg. 2003;75:1781–1784
  42. Suzuki T, Mehta RH, Ince H, et al. Clinical profiles and outcomes of acute type B aortic dissection in the current era: Lessons from the International Registry of Aortic Dissection (IRAD). Circulation. 2003;108(suppl 1):II312–II317
  43. Mehta RH, Bossone E, Evangelista A, et al. Acute type B aortic dissection in elderly patients: Clinical features, outcomes, and simple risk stratification rule. Ann Thorac Surg. 2004;77:1622–1628discussion 1629
  44. Estrera AL, Miller CC, Goodrick J, et al. Update on outcomes of acute type B aortic dissection. Ann Thorac Surg. 2007;83:S842–S845discussion S846-S850
  45. Estrera AL, Miller CC, Safi HJ, et al. Outcomes of medical management of acute type B aortic dissection. Circulation. 2006;114(suppl 1):I384–I389
  46. Palma JH, Almeida DR, Carvalho AC, et al. Surgical treatment of acute type B aortic dissection using an endoprosthesis (elephant trunk). Ann Thorac Surg. 1997;63:1081–1084
  47. Atkins MD, Black JH, Cambria RP. Aortic dissection: Perspectives in the era of stent-graft repair. J Vasc Surg. 2006;43(suppl A):30A–43A
  48. Januzzi JL, Movsowitz HD, Choi J, et al. Significance of recurrent pain in acute type B aortic dissection. Am J Cardiol. 2001;87:930–933
  49. Bozinovski J, Coselli JS. Outcomes and survival in surgical treatment of descending thoracic aorta with acute dissection. Ann Thorac Surg. 2008;85:965–970discussion 970-971
  50. Svensson LG, Kouchoukos NT, Miller DC, et al. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Ann Thorac Surg. 2008;85(suppl 1):S1–S41
  51. Tang DG, Dake MD. TEVAR for acute uncomplicated aortic dissection: Immediate repair versus medical therapy. Semin Vasc Surg. 2009;22:145–151
  52. Parker JD, Golledge J. Outcome of endovascular treatment of acute type B aortic dissection. Ann Thorac Surg. 2008;86:1707–1712
  53. Xiong J, Jiang B, Guo W, et al. Endovascular stent graft placement in patients with type B aortic dissection: A meta-analysis in China. J Thorac Cardiovasc Surg. 2009;138:865–872
  54. Kahn SL, Dake MD. Stent graft management of stable, uncomplicated type B aortic dissection. Perspect Vasc Surg Endovasc Ther. 2007;19:162–169
  55. Slonim SM, Nyman UR, Semba CP, et al. True lumen obliteration in complicated aortic dissection: Endovascular treatment. Radiology. 1996;201:161–166
  56. Dake MD, Kato N, Mitchell RS, et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med. 1999;340:1546–1552
  57. Nienaber CA, Fattori R, Lund G, et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med. 1999;340:1539–1545
  58. Tiesenhausen K, Amann W, Koch G, et al. Endovascular stent-graft repair of acute thoracic aortic dissection—Early clinical experiences. Thorac Cardiovasc Surg. 2001;49:16–20
  59. Lopera J, Patino JH, Urbina C, et al. Endovascular treatment of complicated type-B aortic dissection with stent-grafts: Midterm results. J Vasc Interv Radiol. 2003;14(2 Pt. 1):195–203
  60. Vedantham S, Picus D, Sanchez LA, et al. Percutaneous management of ischemic complications in patients with type-B aortic dissection. J Vasc Interv Radiol. 2003;14(2 Pt. 1):181–194
  61. Duebener LF, Lorenzen P, Richardt G, et al. Emergency endovascular stent-grafting for life-threatening acute type B aortic dissections. Ann Thorac Surg. 2004;78:1261–1266discussion 1266-1267
  62. Dialetto G, Covino FE, Scognamiglio G, et al. Treatment of type B aortic dissection: Endoluminal repair or conventional medical therapy?. Eur J Cardiothorac Surg. 2005;27:826–830
  63. Resch TA, Delle M, Falkenberg M, et al. Remodeling of the thoracic aorta after stent grafting of type B dissection: A Swedish multicenter study. J Cardiovasc Surg (Torino). 2006;47:503–508
  64. Chemelli-Steingruber I, Chemelli A, Strasak A, et al: Endovascular repair or medical treatment of acute type B aortic dissection? A comparison. Eur J Radiol (in press)
  65. Pearce BJ, Passman MA, Patterson MA, et al. Early outcomes of thoracic endovascular stent-graft repair for acute complicated type B dissection using the Gore TAG endoprosthesis. Ann Vasc Surg. 2008;22:742–749
  66. Szeto WY, McGarvey M, Pochettino A, et al. Results of a new surgical paradigm: Endovascular repair for acute complicated type B aortic dissection. Ann Thorac Surg. 2008;86:87–93discussion 93-94
  67. Verhoye JP, Miller DC, Sze D, et al. Complicated acute type B aortic dissection: Midterm results of emergency endovascular stent-grafting. J Thorac Cardiovasc Surg. 2008;136:424–430
  68. Feezor RJ, Martin TD, Hess PJ, et al. Early outcomes after endovascular management of acute, complicated type B aortic dissection. J Vasc Surg. 2009;49:561–566discussion 566-567
  69. Albors J, Bahamonde JA, Juez M, et al. Endovascular stent grafting for acute thoracic aortic pathology. J Card Surg. 2009;24:534–538
  70. Manning BJ, Dias N, Manno M, et al. Endovascular treatment of acute complicated type B dissection: Morphological changes at midterm follow-up. J Endovasc Ther. 2009;16:466–474
  71. Patel HJ, Williams DM, Meerkov M, et al. Long-term results of percutaneous management of malperfusion in acute type B aortic dissection: Implications for thoracic aortic endovascular repair. J Thorac Cardiovasc Surg. 2009;138:300–308
  72. Park KB, Do YS, Kim SS, et al. Endovascular treatment of acute complicated aortic dissection: Long-term follow-up of clinical outcomes and CT findings. J Vasc Interv Radiol. 2009;20:334–341
  73. Slonim SM, Miller DC, Mitchell RS, et al. Percutaneous balloon fenestration and stenting for life-threatening ischemic complications in patients with acute aortic dissection. J Thorac Cardiovasc Surg. 1999;117:1118–1126
  74. Beregi JP, Prat A, Gaxotte V, et al. Endovascular treatment for dissection of the descending aorta. Lancet. 2000;356:482–483
  75. Clair DG. Aortic dissection with branch vessel occlusion: Percutaneous treatment with fenestration and stenting. Semin Vasc Surg. 2002;15:116–121
  76. Gaxotte V, Cocheteux B, Haulon S, et al. Relationship of intimal flap position to endovascular treatment of malperfusion syndromes in aortic dissection. J Endovasc Ther. 2003;10:719–727
  77. Nienaber CA, Zannetti S, Barbieri B, et al. INvestigation of STEnt grafts in patients with type B Aortic Dissection: Design of the INSTEAD trial—A prospective, multicenter, European randomized trial. Am Heart J. 2005;149:592–599
  78. Czermak BV, Waldenberger P, Fraedrich G, et al. Treatment of Stanford type B aortic dissection with stent-grafts: Preliminary results. Radiology. 2000;217:544–550
  79. Sailer J, Peloschek P, Rand T, et al. Endovascular treatment of aortic type B dissection and penetrating ulcer using commercially available stent-grafts. Am J Roentgenol. 2001;177:1365–1369
  80. Pamler RS, Kotsis T, Gorich J, et al. Complications after endovascular repair of type B aortic dissection. J Endovasc Ther. 2002;9:822–828
  81. Palma JH, de Souza JA, Rodrigues Alves CM, et al. Self-expandable aortic stent-grafts for treatment of descending aortic dissections. Ann Thorac Surg. 2002;73:1138–1141discussion 1141-1142
  82. MacKenzie KS, LeGuillan MP, Steinmetz OK, et al. Management trends and early mortality rates for acute type B aortic dissection: A 10-year single-institution experience. Ann Vasc Surg. 2004;18:158–166
  83. Leurs LJ, Bell R, Degrieck Y, et al. Endovascular treatment of thoracic aortic diseases: Combined experience from the EUROSTAR and United Kingdom thoracic endograft registries. J Vasc Surg. 2004;40:670–679discussion 679-680
  84. Eggebrecht H, Nienaber CA, Neuhauser M, et al. Endovascular stent-graft placement in aortic dissection: A meta-analysis. Eur Heart J. 2006;27:489–498
  85. Won JY, Suh SH, Ko HK, et al. Problems encountered during and after stent-graft treatment of aortic dissection. J Vasc Interv Radiol. 2006;17(2 Pt. 1):271–281
  86. Xu SD, Huang FJ, Yang JF, et al. Endovascular repair of acute type B aortic dissection: Early and mid-term results. J Vasc Surg. 2006;43:1090–1095
  87. Schoder M, Czerny M, Cejna M, et al. Endovascular repair of acute type B aortic dissection: Long-term follow-up of true and false lumen diameter changes. Ann Thorac Surg. 2007;83:1059–1066
  88. Jing QM, Han YL, Wang XZ, et al. Percutaneous transluminal stenting in patients with acute and chronic aortic dissections. Zhonghua Nei Ke Za Zhi. 2008;47:281–283
  89. Chang GQ, Li XX, Chen W, et al. Early to mid-term results of endovascular repair of aortic dissection: Report of 165 cases. Zhonghua Wai Ke Za Zhi. 2008;46:752–755
  90. Guangqi C, Xiaoxi L, Wei C, et al. Endovascular repair of Stanford type B aortic dissection: Early and mid-term outcomes of 121 cases. Eur J Vasc Endovasc Surg. 2009;38:422–426
  91. Kaya A, Heijmen RH, Rousseau H, et al. Emergency treatment of the thoracic aorta: Results in 113 consecutive acute patients (the Talent Thoracic Retrospective Registry). Eur J Cardiothorac Surg. 2009;35:276–281
  92. Xenos ES, Minion DJ, Davenport DL, et al. Endovascular versus open repair for descending thoracic aortic rupture: Institutional experience and meta-analysis. Eur J Cardiothorac Surg. 2009;35:282–286
  93. Chemelli-Steingruber IE, Chemelli A, Strasak A, et al. Evaluation of volumetric measurements in patients with acute type B aortic dissection—Thoracic endovascular aortic repair (TEVAR) vs conservative. J Vasc Surg. 2009;49:20–28
  94. Kato N, Shimono T, Hirano T, et al. Midterm results of stent-graft repair of acute and chronic aortic dissection with descending tear: The complication-specific approach. J Thorac Cardiovasc Surg. 2002;124:306–312
  95. Bortone AS, Schena S, D'Agostino D, et al. Immediate versus delayed endovascular treatment of post-traumatic aortic pseudoaneurysms and type B dissections: Retrospective analysis and premises to the upcoming European trial. Circulation. 2002;106(12 suppl 1):I234–I240
  96. Tsai TT, Nienaber CA, Eagle KA. Acute aortic syndromes. Circulation. 2005;112:3802–3813

 Supported in part by National Institutes of Health Cardiovascular Surgery Research Training Grant T32/HL007849 (CMB).

PII: S1043-0679(09)00144-0

doi: 10.1053/j.semtcvs.2009.11.008

Seminars in Thoracic and Cardiovascular Surgery
Volume 21, Issue 4 , Pages 373-386 , Winter 2009