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The Dissected Aorta: Percutaneous Treatment of Ischemic Complications-Principles and Results

Authors
 David M. Williams  ;  Do Y. Lee  ;  Brian H. Hamilton  ;  M. Victoria Marx  ;  Dasika L. Narasimham  ;  Sahira N. Kazanjian  ;  Martin R. Prince  ;  James C. Andrews  ;  Kyung J. Cho  ;  G. Michael Deeb 
Citation
 JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY, Vol.8(4) : 605-625, 1997 
Journal Title
 JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY 
ISSN
 1051-0443 
Issue Date
1997
MeSH
Adult ; Aged ; Aged, 80 and over ; Aneurysm, Dissecting/complications* ; Aneurysm, Dissecting/diagnosis ; Angioplasty, Balloon*/adverse effects ; Angioplasty, Balloon*/methods ; Angioplasty, Balloon*/mortality ; Aortic Aneurysm, Abdominal/complications ; Aortic Aneurysm, Abdominal/diagnosis ; Aortography ; Female ; Follow-Up Studies ; Humans ; Ischemia/diagnosis ; Ischemia/etiology ; Ischemia/therapy* ; Kidney/blood supply ; Leg/blood supply ; Liver/blood supply ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Ultrasonography, Interventional
Abstract
PURPOSE: Describe the principles and results of percutaneous treatment of ischemic complications of aortic dissection. MATERIALS AND METHODS: Twenty-four patients with aortic dissection complicated by ischemic compromise of the liver or bowel (n = 15), kidney (n = 18), or lower extremity (n = 13) were evaluated by means of aortography, intravascular ultrasound, and manometry, and were treated percutaneously. Visceral arteries were classified as obstructed or nonobstructed. Obstruction was classified as static, in which the dissecting hematoma extended into and narrowed the lumen of a branch artery, or dynamic, in which the dissection flap prolapsed into the vessel origin or narrowed the true lumen (TL) above it. Treatment consisted of vascular stents alone (n = 4), or balloon fenestration (n = 20) without (n = 8) or with (n = 12) vascular stents. RESULTS: Obstruction was present in 77 arteries and was static in 12 arteries, dynamic in 45 arteries, static and dynamic in 17 arteries, and indeterminate in three arteries. Percutaneous treatment did not alter false lumen (FL) pressure, but reduced the peak systolic interluminal pressure gradient from 28 mm Hg to 2 mm Hg and restored flow in 71 of 77 arteries (92%). Six patients died within 30 days (25% operative mortality), none as a result of the procedure. Two additional patients died in follow-up from complications of an expanding FL. Technical complications in two patients due to altered hemodynamics after initial intervention were recognized and corrected percutaneously during the same procedure. CONCLUSIONS: Percutaneous fenestration and endovascular stent deployment are indicated to restore blood flow to arteries compromised by aortic dissection. The prognosis of patients is related to the ischemic injury sustained prior to the percutaneous interventional procedure and, in patients with acute type I dissection who have not undergone surgery, to the preoperative stability of the FL.
Full Text
https://www.sciencedirect.com/science/article/pii/S1051044397706195?via%3Dihub
DOI
10.1016/s1051-0443(97)70619-5
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Lee, Do Yun(이도연)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/177353
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