Satisfactory short-term outcomes of the STABILISE technique for type B aortic dissection

Germano Melissano; Luca Bertoglio; Enrico Rinaldi; Daniele Mascia; Andrea Kahlberg; Diletta Loschi; Monica De Luca; Fabrizio Monaco; Roberto Chiesa

doi:10.1016/j.jvs.2018.01.029

Satisfactory short-term outcomes of the STABILISE technique for type B aortic dissection

J Vasc Surg. 2018 Oct;68(4):966-975. doi: 10.1016/j.jvs.2018.01.029. Epub 2018 Mar 30.

Authors

Germano Melissano¹, Luca Bertoglio², Enrico Rinaldi², Daniele Mascia², Andrea Kahlberg², Diletta Loschi², Monica De Luca³, Fabrizio Monaco³, Roberto Chiesa²

Affiliations

¹ Division of Vascular Surgery, "Vita-Salute" University, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: melissano.germano@hsr.it.
² Division of Vascular Surgery, "Vita-Salute" University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
³ Department of Anesthesia and Intensive Care, "Vita-Salute" University, IRCCS San Raffaele Scientific Institute, Milan, Italy.

PMID: 29606568
DOI: 10.1016/j.jvs.2018.01.029

Abstract

Objective: The aim of this study was to evaluate the perioperative and short-term results in a cohort of patients treated during the last year at our institution with the stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair (STABILISE) technique for acute complicated aortic dissection.

Methods: Between June 2016 and June 2017, 10 patients (all male; mean age, 62.6 ± 7.4 years) received treatment for acute complicated aortic dissection with the STABILISE technique. After a standard provisional extension to induce complete attachment procedure using the commercially available endovascular dissection system (Cook Medical, Bloomington, Ind), the distal stent graft area and the bare stent area were ballooned to completely exclude the thoracic false lumen (FL) and to obtain a single-channeled abdominal aorta. Computed tomography was routinely performed within the first postoperative week before discharge and then at 3 months, at 6 months, and yearly thereafter. The technical and clinical success rates were analyzed.

Results: The 30-day technical and clinical success rates were 100%, with complete thrombosis of the thoracic FL and no type I endoleak. Malperfusion was resolved in all cases. No aortic ruptures were recorded, and no open conversion was required. One case of delayed spinal cord ischemia fully resolved within the discharge period. Predischarge computed tomography showed complete thrombosis of the thoracic FL in all cases. In two cases, some degree of patency of the abdominal FL was observed. At short-term follow-up, the overall aortic diameters remained stable with no further dilation.

Conclusions: The STABILISE technique was safe and feasible in this cohort of patients, with complete thrombosis of the thoracic FL and creation of a single-channeled aorta in most cases. Further studies are needed to ascertain the long-term behavior of the treated aorta.

Keywords: Aortic dissection; Ballooning; Bare stent; STABILISE; Type B.

MeSH terms

Acute Disease
Aged
Angioplasty, Balloon / adverse effects
Angioplasty, Balloon / instrumentation
Angioplasty, Balloon / methods*
Aortic Aneurysm / diagnostic imaging
Aortic Aneurysm / physiopathology
Aortic Aneurysm / surgery*
Aortic Dissection / diagnostic imaging
Aortic Dissection / physiopathology
Aortic Dissection / surgery*
Aortography / methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation / adverse effects
Blood Vessel Prosthesis Implantation / instrumentation
Blood Vessel Prosthesis Implantation / methods*
Computed Tomography Angiography
Echocardiography, Transesophageal
Humans
Male
Middle Aged
Retrospective Studies
Stents
Time Factors
Treatment Outcome