TEVAR safe for Stanford type B dissections combined with severe complications


Emergency endovascular therapy is a safe and effective method to treat Stanford type B aortic dissections combined with severe complications, concluded a study presented at the European Society for Vascular Surgery annual meeting in Amsterdam, The Netherlands.

“EVAR is already applied to treat aortic dissection, but if combined with severe complications, it is really challenging. Our objective is to analyse the security and efficiency of endovascular therapy for Stanford type B dissection with severe complications,” said Chang Shu, Xyangya Second Hospital, Central-South University, China.


The study, he said, analysed 290 Stanford type B dissection patients between February 2003 and December 2009. Of those, 65 patients (43 men), with mean age of 42.6+/-10.7 years, presented with severe complications, including huge haemothorax (29), paraplegia (three), acute renal failure (seven), celiac trunk ischaemia (10), superior mesenteric artery ischaemia (11), and critical limb ischaemia (five).


Emergency stent graft deployment was applied in 60 patients. Five patients (two cases of haemothorax, two cases of paraplegia and one case of superior mesenteric artery ischaemia) were given conservative treatment. “Computed tomography scans, duplex ultrasound and laboratory studies were obtained before and after operation,” Shu said.


The five conservative treatment patients died within one month. In the 60 patients who received stent grafts, 64 devices were successfully deployed. “After operation, haemothorax was totally absorbed in 22 of the 29 patients from 28 days to 11 months. Progressive increasing haemothorax was seen in six patients; five cases had puncture drainage (18.5%) and one case had tube drainage (3.7%),” he said. Seven patients need respiratory support two to nine days after operation.


He told delegates that to the renal failure patients, renal function returned to normal one to nine days later, of which three had haemodyalisis for three to seven days after operation (42.9%). Limb and visceral ischaemia, he said, disappeared gradually after endoluminal repair one to 14 days later, and the paraplegia patient began to recover four hours after the stent graft had been deployed. Complication after endoluminal treatment included pleural thickening (six), pulmonary atelectasis (two) and lung consolidation combined with chest dent (two).


He said that all endoluminal treatment patients survived the operation and the three to 86 months follow-up showed enlarged true lumen and thrombosis in the false lumen.


In conclusion, he said, “Endovascular therapy is safe and effective for the cases of acute Stanford type B aortic dissection with hydrothorax.” He added that the reasonable drainage of hydrothorax after stent graft deployed is a must for the patient suffering of respiratory failure. “The early treatment is very important to the patient with dissection combined with hydrothorax.”