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
4
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.
