Percutaneous interventions for treating ischemic complications of aortic dissection

Eur Radiol (2009) 19: 488494DOI 10.1007/s00330-008-1141-4 VASCULAR-INTERVENTIONAL

Percutaneous interventions for treating ischemic complications of aortic dissection

Ajay Chavan Herbert Rosenthal Lars LutheStefanie Pfingsten Ingo KutschkaJerry EasoSiegfried Piepenbrock Otto DapuntAxel Haverich Michael Galanski

Received: 14 April 2008Revised: 14 July 2008Accepted: 18 July 2008Published online: 9 August 2008# European Society of Radiology 2008

A. Chavan (*) . L. Luthe Department of Diagnostic and Interventional Radiology, Klinikum Oldenburg,Rahel Straus Str. 10,26133 Oldenburg, Germany e-mail: chavan.ajay@ klinikum-oldenburg.deTel.: [phone]Fax: [phone]

H. Rosenthal . S. Pfingsten .M. GalanskiDepartment of Radiology, Hannover Medical School, Carl Neuberg Str. 1, 30625 Hannover, Germany

I. Kutschka . A. Haverich Department of Cardio-thoracic Surgery, Hannover Medical School,Carl Neuberg Str. 1,30625 Hannover, Germany

J. Easo . O. DapuntDepartment of Cardio-thoracic Surgery, Klinikum Oldenburg,Rahel Straus Str. 10,26133 Oldenburg, Germany

S. Piepenbrock Department of Anaesthesia, Hannover Medical School, Carl Neuberg Str. 1, 30625 Hannover, Germany

Abstract The aim of this study was to evaluate the role of percutaneous interventions in treating ischemia complicating aortic dissection. Forty-five patients with ischemia complicating aortic dissection were treated by balloon fenestration, true lumen stenting, angioplasty, or thrombolysis. Clinical and laboratory examinations were performed before and after intervention, and at the end of follow-up (median 37 months). Eighteen dissections were acute, 9 sub-acute, and 18 chronic. Mesenterohepatic ischemia resolved in 16 of 18 patients; lactate

and SGOT values fell from 2.89 to1.23 mmol/L (p=0.006) and from 165.9 to 59.7 U/L (p=0.034), respectively. In patients with renal ischemia, creatinine levels fell from 360.1 to 196.3 mol/L (p=0.007) accompanied by a significant reduction in blood pressure. Limb-threatening ischemia resolved in three of four patients; in 21 claudicants, the mean walking distance improved from 272 to 1,283 m (p=0.001). Spinal ischemia resolved completely or partially in six of eight patients. Adjunctive surgical measures were necessary in six patients. Overall 30-day mortality in the 45 patients was 6.7%; all three deaths were in patients with acute dissections (mortality in this subgroup16.7%). Ischemia complicating aortic dissection can be effectively treated by percutaneous interventions resulting in good early and mid-term outcomes.

Keywords Ischemia . Aortic dissection . Balloon fenestration . Stent . Percutaneous intervention

Introduction

Aortic dissection may be complicated by thoraco-abdominal malperfusion in about 1030% of the patients [1, 2]. Such malperfusion complicating type A dissections is generally relieved...