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Endovascular stent placement for acute type-B aortic dissection with malperfusion – an intentional surgical delay and a possible ‘bridging therapy’

Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, 036-8562, Zaifu-cho 5, Hirosaki city, Aomori, Japan

*Corresponding author. Tel.: +81-172-39-5074; fax: +81-172-37-8340.

E-mail address: ikuofuku{at}cc.hirosaki-u.ac.jp (I. Fukuda).

Acute aortic dissection frequently causes life-threatening organ ischemia. The optimal therapy for acute type-B aortic dissection is still controversial. Early surgery for acute dissections with organ malperfusion is known to carry a high morbidity and mortality. Endovascular treatment, such as stent placement for branch stenosis, percutaneous balloon fenestration for compression of the true channel and aortic stent placement to support collapsed true channel, is becoming an alternative form of treatment. However, it is not clear whether endovascular intervention alone is effective in the long term. We herein report a case of emergency percutaneous endovascular stenting with intentional surgical delay in a patient who had visceral and lower extremity malperfusion due to acute type-B dissection. A 10x57 mm bare metal stent was inserted into the obliterated true channel of the thoracoabdominal aorta 3 h after onset of symptoms. It immediately relieved the abdominal and lower limb ischemic symptoms. The advantage of small-sized stent placement is its easiness and being gentle to fragile intima. The small-sized stent placement for patients with acute aortic dissection with visceral organ ischemia may be a promising ‘bridging therapy’ before they undergo traditional central repair.

Key Words: Acute aortic dissection; Small-sized stent; Organ ischemia