Endovascular stent grafting has been successfully used in patients with abdominal and thoracic aneurysms and has been explored as a less invasive alternative in patients with stable type B aortic dissection. Furthermore, stent-graft placement and/or fenestration have also been applied to treat aortic branch occlusions resulting from malperfusion syndromes in both type A and type B acute aortic dissections.
Aims of treatment include reconstruction of the thoracic aortic segment containing the entry tear, induction of thrombosis of the false lumen and reestablishing the true lumen and side branch flow.
The exact role of percutaneous fenestration and stent placement in acute aortic dissection is still evolving. Patients with acute aortic dissection may have life threatening complications manifested by end organ ischemia. The mortality rate of patients with renal ischemia is 50% to 70% and as high as 87% in mesenteric ischemia. Although the surgical success rate at reversing peripheral pulse deficits is high, the surgical in-hospital mortality rates in the setting of end organ ischemia remain as high as 89%. As such, percutaneous management of this complication has emerged as a viable therapy before or after definitive surgical management if needed. In 384 patients with acute type B aortic dissections in the IRAD registry, 46 (12%) were managed with endovascular stent grafting which was similar to the number of patients treated with surgery (56, 15%). Only three (6.5%) died during the initial hospitalization.