Advertisement

Use of the STABILISE technique in the management of subacute type B aortic dissection

  • Alice Lopes
    Correspondence
    Correspondence: Alice Lopes, MD, Serviço de Cirurgia Vascular, Hospital de Santa Maria, Avenida Professor Egas Moniz, Lisboa 1649-035, Portugal
    Affiliations
    Division of Heart and Vessels, Department of Vascular Surgery, Hospital de Santa Maria, Lisbon, Portugal

    Lisbon Academic Medical Center, Lisbon, Portugal

    Lisbon School of Medicine, University of Lisbon, Lisbon, Portugal
    Search for articles by this author
  • Ryan Gouveia e Melo
    Affiliations
    Division of Heart and Vessels, Department of Vascular Surgery, Hospital de Santa Maria, Lisbon, Portugal

    Lisbon Academic Medical Center, Lisbon, Portugal

    Lisbon School of Medicine, University of Lisbon, Lisbon, Portugal
    Search for articles by this author
  • Ruy Fernandes e Fernandes
    Affiliations
    Division of Heart and Vessels, Department of Vascular Surgery, Hospital de Santa Maria, Lisbon, Portugal

    Lisbon Academic Medical Center, Lisbon, Portugal

    Lisbon School of Medicine, University of Lisbon, Lisbon, Portugal
    Search for articles by this author
  • Luís Mendes Pedro
    Affiliations
    Division of Heart and Vessels, Department of Vascular Surgery, Hospital de Santa Maria, Lisbon, Portugal

    Lisbon Academic Medical Center, Lisbon, Portugal

    Lisbon School of Medicine, University of Lisbon, Lisbon, Portugal
    Search for articles by this author
Open AccessPublished:April 14, 2021DOI:https://doi.org/10.1016/j.jvscit.2021.03.009

      Keywords

      The STABILISE (stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair) concept aims to restore the aortic uniluminal anatomy and effectively treat malperfusion syndromes. Despite its novelty, multiple single-center series have demonstrated encouraging early outcomes and positive mid-term aortic remodeling.
      • Lopes A.
      • Gouveia Melo R.
      • Gomes M.L.
      • Garrido P.
      • Junqueira N.
      • Sobrinho G.
      • et al.
      Aortic dissection repair using the STABILISE technique associated with arch procedures: report of two cases.
      • Canaud L.
      • Faure E.M.
      • Ozdemir B.A.
      • Alric P.
      • Thompson M.
      Systematic review of outcomes of combined proximal stent-grafting with distal bare stenting for management of aortic dissection.
      • Melissano G.
      • Bertoglio L.
      • Rinaldi E.
      • Mascia D.
      • Kahlberg A.
      • Loschi D.
      • et al.
      Satisfactory short-term outcomes of the STABILISE technique for type B aortic dissection.
      • Rong D.
      • Ge Y.
      • Liu J.
      • Liu X.
      • Guo W.
      Combined proximal descending aortic endografting plus distal bare metal stenting (PETTICOAT technique) versus conventional proximal descending aortic stent graft repair for complicated type B aortic dissections.
      • Kahlberg A.
      • Mascia D.
      • Bertoglio L.
      • Loschi D.
      • Grandi A.
      • Melissano G.
      • et al.
      New technical approach for type B dissection: from the PETTICOAT to the STABILISE concept.
      We present the case of a 49-year-old man with a medical history significant for severe arterial hypertension who was admitted for type B aortic dissection extending to the right common and left external iliac arteries (Video 1). His systolic blood pressure at admission was 210 mm Hg. Computed tomography angiography demonstrated a patent true lumen (TL) and false lumen (FL). The splenic artery and left renal artery (LRA) originated from the FL, the right renal artery emerged from both lumens, and the remaining visceral arteries originated from the TL. The patient was treated medically initially; however, at 13 days after his presentation, he developed acute kidney injury associated with refractory hypertension and was then considered to have complicated type B aortic dissection.
      A staged hybrid intervention with zone 2 debranching, followed by a STABILISE procedure, was performed (Video 1). A hydrophilic guidewire was introduced through the right common femoral artery to the ascending aorta. Catheterization of the TL was confirmed by small contrast injections at different levels. After exchange for a stiff guidewire, the FL and LRA were catheterized from the left common femoral artery, and a catheter was left in place to assist with subsequent catheterization through the TL.
      A Zenith TX2 stent-graft (Cook Medical, Bloomington, Ind), with planned 10% oversizing, was deployed in the thoracic aorta, followed by two Zenith Dissection stents (Cook Medical) landing 5 cm below the renal arteries. The LRA was then catheterized from the TL through the stent struts, and a Flexor sheath was left in place to secure the patency of the LRA during aortic stent-graft and bare stent dilatation, performed with compliant and noncompliant balloons, respectively. After dilation, a 7 × 32-mm and 6 × 32-mm Advanta V12 (Getinge, Gothenburg, Sweden) were deployed in both renal arteries, with good angiographic control. Completion angiography and postoperative computed tomography angiography confirmed obliteration of the FL and patency of all the branches. The patient had an uneventful recovery. At 12 months of follow-up, the patient was asymptomatic, with adequate blood pressure and a normal creatinine level.
      The patient provided written informed consent for the report of his case.

      Appendix.

      • Loading ...

      References

        • Lopes A.
        • Gouveia Melo R.
        • Gomes M.L.
        • Garrido P.
        • Junqueira N.
        • Sobrinho G.
        • et al.
        Aortic dissection repair using the STABILISE technique associated with arch procedures: report of two cases.
        EJVES Short Rep. 2019; 42: 26-30
        • Canaud L.
        • Faure E.M.
        • Ozdemir B.A.
        • Alric P.
        • Thompson M.
        Systematic review of outcomes of combined proximal stent-grafting with distal bare stenting for management of aortic dissection.
        Ann Cardiothorac Surg. 2014; 3: 223-233
        • Melissano G.
        • Bertoglio L.
        • Rinaldi E.
        • Mascia D.
        • Kahlberg A.
        • Loschi D.
        • et al.
        Satisfactory short-term outcomes of the STABILISE technique for type B aortic dissection.
        J Vasc Surg. 2018; 68: 966-975
        • Rong D.
        • Ge Y.
        • Liu J.
        • Liu X.
        • Guo W.
        Combined proximal descending aortic endografting plus distal bare metal stenting (PETTICOAT technique) versus conventional proximal descending aortic stent graft repair for complicated type B aortic dissections.
        Cochrane Database Syst Rev. 2019; 2019: CD013149
        • Kahlberg A.
        • Mascia D.
        • Bertoglio L.
        • Loschi D.
        • Grandi A.
        • Melissano G.
        • et al.
        New technical approach for type B dissection: from the PETTICOAT to the STABILISE concept.
        J Cardiovasc Surg. 2019; 60: 281-288