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Endovascular treatment of acute Type A dissections -- An early experience
Napoleon Delgado, David Galvez Caballero, Luis Mejia, Carlos E. Donayre.
Instituto Nacional Cardiovascular Clinica Delgado, Lima, Peru.

Objectives: 75% of ascending aortic tears leading to Type A dissections occur 2-3 cm distal to the sino-tubular junction. Coverage of such tears with endograft is being pursued.
Methods: Six patients with an average age of 67.0 years (+/- 14.2 years) presenting with a Type A ascending aortic dissection, not amenable to open repair due to medical comorbidities were identified (ASA IIV grade). None of the dissections were confined to the ascending aorta, with extension into the descending aorta in 3, and into the abdominal aorta also in 3. Presentation, diagnostic studies, management, and outcome were analyzed for each patient.
Results: All patients underwent gated-cardiac CT scans, with proximal landing zones at least 2 cm in length, and diameters of the ascending aorta true lumen ranged from 22.2 to 30.1 cm. Deployment of aortic cuffs into the ascending aorta was either from the right carotid (n=2) or femoral (n=4) access. Additional deployment of thoracic stent-grafts in the descending aorta was done in 5 patients. There were no procedural mortalities, and all survived 30-days, with an ICU stay of 3.4 days (+/-1.0 day), and a length of stay of 10.3 days (+/-3.2 days). Mean follow-up is 21 months (range 8 -26 months). A secondary procedure was required in one patient (stent-graft deployment). There was only one death at one year of follow-up. Positive remodeling of the ascending aorta and proximal descending aorta was seen (See table)
Conclusions: Endovascular treatment of acute Type A dissections is possible in high-risk patients with an associated low mortality and morbidity by relying in rigid anatomic criteria. Positive remodeling of the ascending aorta is also observed. Longer-term follow-up and development of branched ascending aortic endografts are needed to expand the use of this technology.
Aortic remodeling following endograft deployment of Type A dissections
AnatomicTrueLumenfalseLumen
LevelPre Diameter (cm)Post Diameter (cm)Pre Diameter (cm)Post Diameter (cm)
Proximal Ascending Aorta22.236.434.16.3
Mid-ascending Aorta25.433.325.811.2
Distal Ascending Aorta30.137.413.63.6
Proximal Descending Aorta14.5`31.219.53.1


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