Percutaneous balloon fenestration and stenting for life-threatening ischemic complications in patients with acute aortic dissection

S. M. Slonim, D. C. Miller, R. S. Mitchell, C. P. Semba, M. K. Razavi, M. D. Dake, S. H. Merrick

Research output: Contribution to journalArticle

166 Citations (Scopus)

Abstract

Objectives: Acute aortic dissection frequently causes life-threatening ischemia of end-organs, historically associated with mortality exceeding 60%. Reperfusion with the use of interventional radiologic methods has evolved as a promising treatment. We report results of our initial 6 years of experience with percutaneous balloon fenestration of the intimal flap and endovascular stenting. Methods: Forty patients (32 male and 8 female) with a median age of 53 years (range 16-86 years) underwent percutaneous treatment for peripheral ischemic complications of 10 type A and 30 type B acute aortic dissections since 1991. Twenty patients had ischemia of multiple organ systems. Thirty patients had renal, 22 had leg, 18 had mesenteric, and 1 had arm ischemia. Results: Fourteen patients were treated with stenting of either the true or false lumen combined with balloon fenestration of the intimal flap, 24 with stenting alone, and 2 with fenestration alone. Successful revascularization was achieved in 93% ± 4% (±70% confidence levels) of patients (37/40). Nine patients had procedure-related complications. The 30-day mortality rate was 25% ± 7% (10/40), often related to irreversible ischemia of intra-abdominal organs that was present before the procedure. Of the remaining 30 patients, 5 have died and the remaining 25 continue to have relief of ischemic symptoms at a mean follow-up of 29 months. Conclusion: Percutaneous balloon fenestration of the intimal flap and endovascular stenting is an effective treatment for life-threatening ischemic complications of acute aortic dissection.

Original languageEnglish (US)
Pages (from-to)1118-1127
Number of pages10
JournalJournal of Thoracic and Cardiovascular Surgery
Volume117
Issue number6
DOIs
StatePublished - Jan 1 1999
Externally publishedYes

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Dissection
Tunica Intima
Ischemia
Mortality
Reperfusion
Leg
Arm
Therapeutics
Kidney

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Percutaneous balloon fenestration and stenting for life-threatening ischemic complications in patients with acute aortic dissection. / Slonim, S. M.; Miller, D. C.; Mitchell, R. S.; Semba, C. P.; Razavi, M. K.; Dake, M. D.; Merrick, S. H.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 117, No. 6, 01.01.1999, p. 1118-1127.

Research output: Contribution to journalArticle

Slonim, S. M. ; Miller, D. C. ; Mitchell, R. S. ; Semba, C. P. ; Razavi, M. K. ; Dake, M. D. ; Merrick, S. H. / Percutaneous balloon fenestration and stenting for life-threatening ischemic complications in patients with acute aortic dissection. In: Journal of Thoracic and Cardiovascular Surgery. 1999 ; Vol. 117, No. 6. pp. 1118-1127.
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abstract = "Objectives: Acute aortic dissection frequently causes life-threatening ischemia of end-organs, historically associated with mortality exceeding 60{\%}. Reperfusion with the use of interventional radiologic methods has evolved as a promising treatment. We report results of our initial 6 years of experience with percutaneous balloon fenestration of the intimal flap and endovascular stenting. Methods: Forty patients (32 male and 8 female) with a median age of 53 years (range 16-86 years) underwent percutaneous treatment for peripheral ischemic complications of 10 type A and 30 type B acute aortic dissections since 1991. Twenty patients had ischemia of multiple organ systems. Thirty patients had renal, 22 had leg, 18 had mesenteric, and 1 had arm ischemia. Results: Fourteen patients were treated with stenting of either the true or false lumen combined with balloon fenestration of the intimal flap, 24 with stenting alone, and 2 with fenestration alone. Successful revascularization was achieved in 93{\%} ± 4{\%} (±70{\%} confidence levels) of patients (37/40). Nine patients had procedure-related complications. The 30-day mortality rate was 25{\%} ± 7{\%} (10/40), often related to irreversible ischemia of intra-abdominal organs that was present before the procedure. Of the remaining 30 patients, 5 have died and the remaining 25 continue to have relief of ischemic symptoms at a mean follow-up of 29 months. Conclusion: Percutaneous balloon fenestration of the intimal flap and endovascular stenting is an effective treatment for life-threatening ischemic complications of acute aortic dissection.",
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