• Revista médica de Chile · Nov 2008

    [Endovascular treatment of type B aortic dissection].

    • Renato Mertens, Ivette Arriagada, Francisco Valdés, Albrecht Krämer, Leopoldo Mariné, Michel Bergoeing, Sandra Braun, Iván Godoy, Samuel Córdova, Alvaro Huete, Jeannette Vergara, and Claudia Carvajal.
    • Departamento de Cirugía Vascular y Endovascular, División de Cirugía, Pontificia Universidad Católica de Chile. rmertens@manquehue.net
    • Rev Med Chil. 2008 Nov 1; 136 (11): 143114381431-8.

    BackgroundDissections that involve the ascending aorta are classified as type A, regardless of the site of the primary intimal tear, and all other dissections as type B. Type B dissections can have fatal ischemic and hemorrhagic complications. In the chronic state, dilatation and rupture can be mortal. Endovascular surgery is a therapeutic alternative, considering the high rate of complications of conventional surgery.AimTo report the results of endovascular treatment of type B aortic dissection.Material And MethodsReport of 36 treated patients (30 males) aged 43 to 87 years, with a type B aortic dissection. Seventy eight percent were hypertensive and 39% smoked. The diagnosis was confirmed by CAT scan. Acute patients were treated for complications and chronic patients, for dilatation. In the operating room, an endoprothesis was placed through the femoral artery, to cover the tear. The tear was located and the lumens were differentiated using angiography and transesophageal echocardiography.ResultsAll procedures were successful. In 16 acute dissections the indications were malperfusion syndrome or unmanageable hypertension in seven patients and imminent rupture or persistent pain in nine. Twenty chronic patients were operated due to dilatation (mean 6 cm). One patient died due to cardiac failure. One patient had a transient paraparesia and two had pulmonary embolism. No patient died in a follow up period ranging from 2.5 to 74 months. Four patients required a new aortic endovascular procedure due to progressive dilatation or endoleak.ConclusionEndovascular treatment of type B aortic dissection has good immediate and long term results.

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