UK Vascular Surgeon Discusses Endograft Treatment Of Chronic Type B Dissecting Aneurysm And Possible Need For A Secondary Intervention

Main Category: Cardiovascular / Cardiology
Article Date: 24 Nov 2008 - 3:00 PDT

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Endovascular treatment of chronic dissections is an evolving field. Dr. Matt Thompson, Professor at the University of London and Professor of Vascular Surgery at St. George's Vascular Institute in London, discussed the controversies, particularly concerning how extensive the repair needs to be. With an acute dissection, he pointed out that coverage of the tear should be sufficient.

However, in the situation of a chronic dissection, defined by more than two weeks from symptom onset, extensive endovascular coverage is required. The natural history of chronic dissections is not well defined, but in many series patients appear to have a high longterm mortality.

A conservative interpretation of these series is that a substantial proportion of patients with a stable, asymptomatic Type B dissection progress to lesions that cause aortic related death. Dr. Thompson stated that endovascular treatment of chronic dissections appears to be a well tolerated procedure, with acceptable mortality rates and reasonable paraplegia and stroke rates. In most series it appears that the early results of endovascular repair of chronic dissections is encouraging.

Dr. Thompson addressed the main issues concerning the durability of the endovascular repair and whether endovascular coverage in chronic dissections actually prevents aortic rupture. In addition, vascular surgeons are debating the need for secondary intervention following endovascular repair of chronic dissection and whether more extensive initial coverage of the dissection limits subsequent intervention.

Stated Dr. Thompson: "After a high rate of secondary interventions we now routinely stent to the diaphragm in the primary procedure."

The strategy for endovascular repair requires further attention in the long-term as to the necessity for closure of both primary entry tear and subsequent re-entry sites.

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Source
Pauline T. Mayer
www.ptmhcm.com