American College of Surgeons American College of Surgeons Presenter Disclosure SlidePresenter Disclosure Slide

Chang Shu

2010 Clinical CongressAmerican College of Surgeons ♦ Division of Education

Endovascular Repair of Standford Type B Aortic Dissections with

Severe Complications

Endovascular Repair of Standford Type B Aortic Dissections with

Severe Complications

Chang ShuDepartment of Vascular Surgery, Xiang-Ya Second

Hospital, Central-South University, China

Chang ShuDepartment of Vascular Surgery, Xiang-Ya Second

Hospital, Central-South University, China

Clinical Materials

2003.2—2009.12 Among 290 Stanford type B AD patients, 65 (22.4%) patients Male: 43 Female: 22 Age of 42.6±10.7years (range 34-71 years), Presented with severe complications,

Clinical Materials

Complications including: huge hemothorax 29; paraplegia 3; acute renal failure 7; celiac trunk ischemia 10; superior mesenteric artery ischemia 11; severe limb ischemia 5.

Clinical Materials

Emergency stent-graft deployment were applied in 60 patients, 64 stent-grafts were applied.

Five patients were given conservative treatment : ( hemothorax 2, paraplegia 2,

superior mesenteric artery ischemia 1 ) CT scans, duplex ultrasound, laboratory studies

were obtained before and after operation.

Huge hemothorax: 29 cases

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2

3

4

The Range of oxygen saturation index: 85%-67%The Range of oxygen saturation index: 85%-67%

To be supported by respirator: 7 (7/29)To be supported by respirator: 7 (7/29)

Combined with ischemia of the viscera: 3 (3/29)Combined with ischemia of the viscera: 3 (3/29)

To be diagnosed respiratory failure: 10 (10/29)To be diagnosed respiratory failure: 10 (10/29)

Result

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2

3

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Mortality: 0%Mortality: 0%

hydrothorax to be totally absorbed : 22 cases, 28days-11 months after the stent-graft treatment hydrothorax to be totally absorbed : 22 cases, 28days-11 months after the stent-graft treatment

Respiratory support after operation: 7 (7/29). Range: 2-9 daysRespiratory support after operation: 7 (7/29). Range: 2-9 days

Six (6/29) progressive increasing hydrothorax after the procedure: drainage tube to be used:1. Puncture drainage 5.

Six (6/29) progressive increasing hydrothorax after the procedure: drainage tube to be used:1. Puncture drainage 5.

Complications after endoluminal treatment

Pleural thickening: 6.

Pulmonary atelectasis: 2

Lung consolidation combined with chest dent: 2

Conclusion

Endovascular therapy is safe and effective for

the cases of acute Stanford type B aortic

dissection with hydrothorax.

The reasonable drainage of hydrothorax after

stent-graft deployed is a must for the patient

suffered from respiratory failure.

The early treatment Is very important to the patient

with dissection combined with hydrothorax.

Male, 56 years-old,Suffered from aortic dissection

combined with resperatory failure:Before operation

After operation, 3 months later

Male, 56 years-old,Suffered

from aortic dissection

Respiratory support before operation

Three months later, false lumenAlmost disppeared,

Lung consolidation combined with chest dent

Male, 63 years-old, breath supported by the machine before operation

Three days later after deploy the stent-graft

11 months later, false lumen disspeared, and the chest is very clean for we drainge it after deployed the stent-graft

Combined with acute kidney failure

Seven aortic dissection combined with kidney failure:

6 patients had been given hemodialysis before being treated by stent-graft (3days-2 weeks)

1 patient suffered from kidney failure for 2 days

Result

All patients survived: 3 (3/7) patients need hemodialysis after the

endoluminal treatment for 3-7days. 4( 4/7) patients need not hemodialysis after the

stent-graft deployed, the DSA shows the instantly blood supply of the renal artery for the true lumen opened.

Before operation:The right renal false lumen

After deploy the stent-graft

Aortic dissection combined with paraplegia

Three patients suffered from paraplegia after aortic dissection happened. Only one patient had been given stent-graft treatment.

Male, 60 years-old. Suffered from aortic dissection 1 day, paraplegia happened, we gave him emergency stent-graft deployed, and drainage the spinal cord, use large dose of hormone. He can move his extremities after 4 hours later of the operation.

Before operation

2 weeks later of the stent-graft deployed

With ischemia of the celiac or SMA, Lower limbs

celiac trunk ischemia 10; Superior mesenteric artery ischemia 11;

(10 treated by stent-graft) Severe limb ischemia 5.

The true lumen is totally compressed by the false lumen, we have to put the guide wire from the subclavian to the femoral artery

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The stent-graft is deployed

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The true lumen is opened, although some visceral arteries are still coming from the false lumen, the patients has no ischemia symptoms

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Result

Limb and visceral ischemia disappeared gradually after endoluminal repair 1 to 14 days later, and the paraplegia patient begin to recover 4 hours later after stent-graft deployed. All endoluminal treatent patients were kept alive and the 3-86 months follow up showed that enlarged true lumen and thrombosis in the false lumen.

Conclusion

Emergency endovascular therapy is a safe and effective method to treat Standford type B AD combined with severe complications.