1. American College of Surgeons Presenter Disclosure Slide Chang Shu 2010 Clinical Congress American College of Surgeons ♦ Division of Education

2. Endovascular Repair of Standford Type B Aortic Dissections with Severe Complications Chang Shu Department of Vascular Surgery, Xiang-Ya Second Hospital, Central-South University, China Chang Shu Department of Vascular Surgery, Xiang-Ya Second Hospital, Central-South University, China

3. Clinical Materials  2003.2—2009.12 Among 290 Stanford type B AD patients, 65 (22.4%) patients Male: 43 Female: 22 Age of 42.6±10.7years (range 34-71 years), Presented with severe complications,

4. Clinical Materials  Complications including: huge hemothorax 29; paraplegia 3; acute renal failure 7; celiac trunk ischemia 10; superior mesenteric artery ischemia 11; severe limb ischemia 5.

5. Clinical Materials  Emergency stent-graft deployment were applied in 60 patients, 64 stent-grafts were applied.  Five patients were given conservative treatment : ( hemothorax 2, paraplegia 2, superior mesenteric artery ischemia 1 )  CT scans, duplex ultrasound, laboratory studies were obtained before and after operation.

6. Huge hemothorax: 29 cases 1 2 3 4 The Range of oxygen saturation index: 85%-67% To be supported by respirator: 7 (7/29) Combined with ischemia of the viscera: 3 (3/29) To be diagnosed respiratory failure: 10 (10/29)

7. Result 1 2 3 4 Mortality: 0% hydrothorax to be totally absorbed : 22 cases, 28days- 11 months after the stent-graft treatment Respiratory support after operation: 7 (7/29). Range: 2-9 days Six (6/29) progressive increasing hydrothorax after the procedure: drainage tube to be used:1. Puncture drainage 5.

8. Complications after endoluminal treatment  Pleural thickening: 6.  Pulmonary atelectasis: 2  Lung consolidation combined with chest dent: 2

9. Conclusion  Endovascular therapy is safe and effective for the cases of acute Stanford type B aortic dissection with hydrothorax.  The reasonable drainage of hydrothorax after stent-graft deployed is a must for the patient suffered from respiratory failure.  The early treatment Is very important to the patient with dissection combined with hydrothorax.

10. Male, 56 years-old, Suffered from aortic dissection combined with resperatory failure:Before operation

11. After operation, 3 months later

12. Male, 56 years-old, Suffered from aortic dissection

13. Respiratory support before operation

14. Three months later, false lumen Almost disppeared, Lung consolidation combined with chest dent

15. Male, 63 years-old, breath supported by the machine before operation

16. Three days later after deploy the stent-graft

17. 11 months later, false lumen disspeared, and the chest is very clean for we drainge it after deployed the stent-graft

18. Combined with acute kidney failure  Seven aortic dissection combined with kidney failure: 6 patients had been given hemodialysis before being treated by stent-graft (3days-2 weeks) 1 patient suffered from kidney failure for 2 days

19. Result  All patients survived: 3 (3/7) patients need hemodialysis after the endoluminal treatment for 3-7days. 4( 4/7) patients need not hemodialysis after the stent-graft deployed, the DSA shows the instantly blood supply of the renal artery for the true lumen opened.

20. Before operation: The right renal false lumen

21. After deploy the stent-graft

22. Aortic dissection combined with paraplegia  Three patients suffered from paraplegia after aortic dissection happened. Only one patient had been given stent-graft treatment.  Male, 60 years-old. Suffered from aortic dissection 1 day, paraplegia happened, we gave him emergency stent-graft deployed, and drainage the spinal cord, use large dose of hormone. He can move his extremities after 4 hours later of the operation.

23. Before operation

24. 2 weeks later of the stent-graft deployed

25. With ischemia of the celiac or SMA, Lower limbs celiac trunk ischemia 10; Superior mesenteric artery ischemia 11; (10 treated by stent-graft) Severe limb ischemia 5.

26. The true lumen is totally compressed by the false lumen, we have to put the guide wire from the subclavian to the femoral artery 26

27. The stent-graft is deployed 27

28. The true lumen is opened, although some visceral arteries are still coming from the false lumen, the patients has no ischemia symptoms 28

34. Result  Limb and visceral ischemia disappeared gradually after endoluminal repair 1 to 14 days later, and the paraplegia patient begin to recover 4 hours later after stent-graft deployed. All endoluminal treatent patients were kept alive and the 3-86 months follow up showed that enlarged true lumen and thrombosis in the false lumen.

35. Conclusion  Emergency endovascular therapy is a safe and effective method to treat Standford type B AD combined with severe complications.