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Percutaneous interventions for treating ischemic complications of aortic dissection

  • Vascular-Interventional
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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 to 1.23 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 μmol/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 subgroup 16.7%). Ischemia complicating aortic dissection can be effectively treated by percutaneous interventions resulting in good early and mid-term outcomes.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Klinikum Oldenburg, Rahel Straus Str. 10, 26133, Oldenburg, Germany

    Ajay Chavan & Lars Luthe

  2. Department of Radiology, Hannover Medical School, Carl Neuberg Str. 1, 30625, Hannover, Germany

    Herbert Rosenthal, Stefanie Pfingsten & Michael Galanski

  3. Department of Cardio-thoracic Surgery, Hannover Medical School, Carl Neuberg Str. 1, 30625, Hannover, Germany

    Ingo Kutschka & Axel Haverich

  4. Department of Cardio-thoracic Surgery, Klinikum Oldenburg, Rahel Straus Str. 10, 26133, Oldenburg, Germany

    Jerry Easo & Otto Dapunt

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

    Siegfried Piepenbrock

Authors
  1. Ajay Chavan
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  2. Herbert Rosenthal
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  3. Lars Luthe
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  4. Stefanie Pfingsten
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  5. Ingo Kutschka
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  7. Siegfried Piepenbrock
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  9. Axel Haverich
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  10. Michael Galanski
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Correspondence to Ajay Chavan.

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Chavan, A., Rosenthal, H., Luthe, L. et al. Percutaneous interventions for treating ischemic complications of aortic dissection. Eur Radiol 19, 488–494 (2009). https://doi.org/10.1007/s00330-008-1141-4

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  • DOI: https://doi.org/10.1007/s00330-008-1141-4

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