Problems encountered during and after stent-graft treatment of aortic dissection

PURPOSE: The authors report their experiences with the problems encountered during and after stent-graft placement in patients with aortic dissections. MATERIALS AND METHODS: Between July 1994 and December 2003, stent-graft placement was performed in 60 patients with aortic dissections, 9 patients with Stanford type A dissection and 51 patients with type B. Ten patients had acute dissection and 50 patients had chronic dissection. Each patient was followed for 12 to 107 months (mean, 33 mo). All cases were retrospectively reviewed for any problem that occurred during and after the procedure. RESULTS: During the procedure, there were two cases (3%) of stent-graft migration, one case (2%) of stent-graft torsion, two cases (3%) of stent-graft folding due to oversizing, three cases (5%) of persistent thoracic false lumen flow by the appearance of a hidden intimal tear, one case (2%) of new intimal tear that resulted in retrograde type A dissection, and 12 cases (20%) of type I endoleaks on aortograms taken immediately after the procedure. During the follow-up period, one case (2%) of transient cerebral ischemia, six cases (10%) of persistent type I endoleaks, two cases (3%) of type II endoleaks through the intercostal artery, four cases (7%) with progressive dilatation of abdominal false lumen, six cases (10%) of new intimal tears which resulted in saccular aneurysms (n = 4) or new dissections (n = 2) on either or both ends of the stent-graft, and two cases (3%) of mechanical failure were observed. Overall, five patients (8%) required surgical conversion, and there were no cases of procedure-related mortality. CONCLUSION: Various problems can occur during and after stent-graft placement in aortic dissection. The thorough evaluation of preoperative imaging and close follow-up are mandatory to optimize the management of such problems.