Strategies to prevent stent perforation after chronic type B aortic dissection endovascular repair

20 Oct 2016

There are several strategies that can be applied to avoid stent perforation after chronic type B aortic dissection (CBAD) endovascular repair, including prudent sizing, extending the stent beyond the curvature of the descending thoracic aorta, and ensuring a dissection-free distal landing zone, according to a study presented at the ASEAN Federation of Cardiology Congress (AFCC) 2016 in Yangon, Myanmar.

Although CBADs are amenable to endovascular treatment, stents are associated with specific complication, researchers said.

A retrospective review over 7 years was performed, which involved patients with CBAD treated with thoracic endovascular aortic repair (TEVAR), to examine cases of stent perforation and discuss some preventive strategies.

The study included 3 cases with eventual stent perforation. These cases comprised 3 males aged 59, 66, and 70 years with a past medical history of hypertension. Previous surgeries were noted: 1 patient had an open repair for CBAD with infrarenal aneurysm and another had ascending aorta replacement for type A dissection.

Patient 1 had TEVAR perforation at 2 months and endoleak at 5 years. Patient 2 had 7.7 cm false lumen aneurysm and new dissection after 4 years. Patient 3 had 7.7 cm false lumen with thrombus and TEVAR complicated by endoleak.

“Intervention for CBAD can be performed with excellent results, either by an open or endovascular approach. The higher rate of treatment failure after TEVAR warrants modification of current device design or endovascular approach before broad application of this treatment strategy,” Van Bogerijen et al concluded in a previous study. [Ann Thorac Surg 2015;99:1260-6]

Continued surveillance is required even with apparent thrombosis or resolution of the false lumen, according to researchers.

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