• Stephan Kische, Giuseppe D'Ancona, Ioan Christian Belu, Yannik Stoeckicht, Umut Agma, Jasmin Ortak, and Hüseyin Ince.
• Department of Cardiology and Cardiac Intervention, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany Rostock University Medical Center, Rostock, Germany.
• Eur J Cardiothorac Surg. 2015 Oct 1; 48 (4): e77-84.

ObjectivesTo present results of endovascular treatment of complicated type B aortic dissection.MethodsPatients with acutely complicated type B aortic dissection extending from the left sub-clavian artery to the abdominal aorta were treated. The strategy involved the placement of a covered endoprosthesis to seal the primary entry tear and, in cases where malperfusion persisted, distal extension with uncovered stents, to enhance true lumen (TL) expansion and reperfusion of the ischaemic arterial branches originating from the TL.ResultsThirty-five patients were included. Mean age was 63.1 (37-79) years and malperfusion syndrome occurred in 71.4%. Average aortic coverage with endoprostheses was 220.6 mm (136-355 mm). In 17 cases (48.5%), distal extension with uncovered stents was necessary. Thirty-day major morbidity was 28.5%, and mortality 2.8%. At follow-up (25.6 ± 19.5 months; 4-73 months), overall mortality was 15.2%, and aortic mortality 12.1%. Additional aortic intervention was necessary in 18.2%. Although patients undergoing distal extension with bare metal stents suffered most often from preoperative malperfusion, no significant differences were noted in the 30-day and follow-up clinical results. Follow-up angio-computed tomography showed complete thrombosis of the false lumen in the proximal half of the thoracic aorta in 76.4%. Patients treated with bare stents had significantly larger aortic TL sizes, at the different abdominal aorta levels.ConclusionsIn patients with complicated type B aortic dissection, tailored elongation with uncovered stents is a safe treatment of persistent malperfusion. Although the results presented are encouraging, randomized data and a longer follow-up are required to confirm benefits and complications of this strategy.© The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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