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The Fate Of The Visceral Arteries After Stent-Graft Implantation In Patients With Acute Type B Dissection
Marie-Elisabeth Stelzmueller1, Vera Leonhard2, Dominik Wiedemann1, Stephane Mahr1, Alfred Kocher1, Marek Ehrlich1, Günther Laufer1, Johannes Lammer2, Christian Loewe2, Florian Wolf2, Maria Schoder2, Martin Funovics2.
1Medical University Vienna/ Department of Cardiac Surgery, Vienna, Austria, 2Medical University Vienna/ Department of Cardiovascular and Interventional Radiology, Vienna, Austria.
OBJECTIVE: Endovascular stent-graft implantation represents an established treatment option for patients with acute type B-dissection, with satisfying postinterventionel results. The aim of this study was to analyse the midterm results of visceral artery stenosis, after stent-graft implantation.
METHODS: Patients undergoing stent-graft implantation for type-B dissection between January 2005 and December 2010 were included in this study. Postinterventionel and latest follow up CT scans were examined, the visceral arteries (VA) were characterizes by departure from true/false/both lumen, degree of stenosis (<50%, 50-75%, 75-100%) and the length of the monitoring period.
RESULTS: A total of 144 VA were investigated, 125 VA were supplied from the true lumen (VATL), whereby in 10 cases (8%) a deterioration in the degree of stenosis could be observed at the end of observation period (mean 42 month). 19 VA departed completely or partially from the false lumen (VAFL/VAPL). 4 (21%) of which showed a progression of stenosis. The mean freedom of increasing stenosis in the VATL was 95.4 month, compared to the VAFL/VAPL group with 61.5 month (p=0,018, log rank).
CONCLUSIONS: In conclusion, visceral arteries after stent-graft implantation in patient with acute type-B dissection, supplied completely or partially from the false lumen are more likely for progression in stenosis. Therefore a closer observation as well as careful evaluation for reinterventions are indispensable.
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