Endovascular procedures for the treatment of aortic dissection: Techniques and results

Since its pathological recognition over 250 years ago, aortic dissection remains associated with significant morbidity and mortality despite significant advances in its surgical management. Recently, endovascular techniques are emerging as alternatives to open surgical treatment of this vexing challenge. We report our clinical experience over the last four years with endovascular stents, stent-grafts, and percutaneous balloon fenestration of the dissection septum to treat peripheral ischemic complications associated with aortic dissection. Fifty-three patients underwent 59 procedures to revascularize ischemic aortic branches in the setting of acute and chronic dissection; 230 patients with type A and 33 patients with type B aortic dissection were treated. Technically successful revascularization was achieved in 50 of the 53 patients. The 30-day mortality is 15%. The mean follow-up interval is 23 months and there have been no late deaths related to aortic dissection or the endovascular procedure. Initial experience suggests that further evaluation of these new endovascular techniques is clearly warranted in high-risk patients with aortic dissection who have appropriate clinical indications for interventions.