Thoracic Endovascular Aortic Repair And Open Surgery Strategy For Chronic Type B Dissection
Masato Furui, Shoji Sakaguchi, Bunpachi Kakii, Gaku Uchino, Takeshi Yoshida.
Matsubara Tokushukai Hospital, Matsubara , Osaka, Japan.
OBJECTIVE: Recently, thoracic endovascular aortic repair(TEVAR) is often performed for acute type B dissection accompanied with complications or for the purpose of preventing further expansion of false lumen, but isn’t established for chronic type B dissection yet. However, the treatment by only open surgery for these chronic dissection is so invasive that less invasive treatment by the combination with TEVAR has more advantages. So we evaluated the results of staged surgical treatment by using TEVAR for chronic type B dissection.
METHODS: From December 2010 to May 2016, first of all, TEVAR was performed for 5 patients(mean 60±15(44-77)years old) who had chronic dissection in arch and descending aorta but needed additional treatment. The cause of four cases was expanding of aorta and other cause was disseminated intravascular coagulation(DIC) by residual blood flow in false lumen. As open procedure, inner artificial vessel of stentgraft was fixed with outer felt like sandwich under cardio pulmonary bypass(CPB) after stentgraft expanded by fenestration. False lumen was closed by this procedure. We examined operative and CPB time, respiratory influence like prolonged ventilator management, complication, hospital stay and outcome.
RESULTS: The average operative time was 259±42 min and CPB time was 65±30 min. There was none of major operative complication such as respiratory failure and paraplegia. And all patients were discharged well. The average hospital stay was 25±9 days and postoperative period was 15±5 days. There was no case to need additional treatment due to enlargement of false lumen although mean observational period was 14±11 (4-36)months at this time.
CONCLUSIONS: First TEVAR and secondary open surgical false lumen closure for chronic type B dissection had acceptable results including hospital stay, postoperative periods and complication rate. This staged treatment by the combination with TEVAR and false lumen closure is less invasive than open surgery only and may be one option for chronic type B dissection.
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