Endovascular Stent Graft Repair of Aortic Dissection Type B Extending to the Aortic Arch

ObjectiveTo analyse our experience with endovascular stent graft repair of descending aorta dissections that require supraaortic branch vessel revascularisation.DesignRetrospective study.MethodsFrom 2001 to 2009, 22 consecutive patients with the above dissections were retrospectively analysed. Inclusion requirement: aortic landing zone proximal to the left subclavian artery of less than 15 mm. Hybrid, scalloped or fenestrated endovascular stent grafts were selected based on dissection characteristics. Annual follow-up visits (median 27.1 months) included computed tomography angiography. End points include progressive pathology, complications and survival rates.ResultsSurgery was successful in all except for one operative complication. Two patients died within 30 days after surgery, one to cerebral infarction and the other to myocardial infarction. No postoperative complications occurred in the remaining patients. Thrombosis formed in the aortic false lumen of the graft exclusion segment in all patients. The maximum diameter of this segment decreased in 18 patients and was stable in two. In 19 patients, blood flow remained in the false lumen distal to the exclusion area not covered by stent. Patency was seen at mid- and long-term follow-up, without proximal endoleak, graft displacement or deaths.ConclusionEndovascular stent graft methods show promise in endovascular stent graft repair of proximal descending aortic dissections involving the distal arch.