管腔内支架人工血管治疗急性胸降主动脉夹层动脉瘤

目的 探讨管腔内支架替代传统手术治疗急性胸降主动脉夹层动脉瘤的可行性及效果.方法 从2003年6月至2005年6月,12例急性胸降主动脉夹层动脉瘤患者接受管腔内支架人工血管治疗.结果 12例患者无死亡.共放支架12支,胸降主动脉受压夹层真腔全部恢复正常管径,无中转手术.术后3个月、1年随访,行CTA检查未发现与支架有关的并发症.结论管腔内支架人工血管治疗急性胸降主动脉夹层动脉瘤是一种有效的治疗方法.     

B型不典型主动脉夹层的腔内修复术治疗及中期随访结果

目的: 总结临床较少见的B型主动脉不典型夹层的腔内修复治疗患者的临床资料及中期随访结果。方法: 总结自2009年4月~2009年10月连续10例采用腔内覆膜支架植入术的B型主动脉不典型夹层的临床资料及治疗方法,并进行随访。结果: 所有患者均为男性。年龄（54±11）岁,体质量（80±6） kg。所有患者均有急性胸背部疼痛症状,经64排螺旋CT确诊为B型主动脉不典型夹层,其中8例存在主动脉壁内血肿,9例存在主动脉穿通性溃疡,7例两者共存。3例存在胸腔积液,4例CT提示造影剂外溢。所有患者均有高血压病史,诊断高血压病1～30（8±10）年。最高血压150～230（189±31）mmHg,6例患者诊断有高血脂,7例患者经CT诊断有严重动脉硬化。所有10例患者采用介入腔内覆膜支架修复术,从疼痛症状发生到支架植入时间6～60（19±16） d, 急性患者6例,慢性患者4例。所有患者均成功植入覆膜支架。植入支架直径（35.4±1.9） mm,支架长度（150±9） mm。ICU时间为4 h～2（1.0±0.6） d,术后（5.9±1.5） d出院。其中1例患者同期植入一枚肾动脉支架。1例术后第2天起有轻度偏瘫症状,术后CT证实左侧顶叶小梗死灶,经治疗好转出院。所有患者均进行随访,随访5～11（8.4±2.1）个月。1例术后2周时在家中不明原因猝死。其余患者在术后4 d及术后3个月时均行CT复查,恢复满意,症状消失。结论: 主动脉腔内覆膜支架修复术对有症状且有演变成典型夹层或破裂倾向的B型主动脉不典型夹层治疗的近,中期效果良好,是一种安全,有效,成功率高的治疗方法,远期效果需进一步随访。     

Endovascular stent-graft placement in aortic dissection: a meta-analysis.

AIMS: This article summarizes all available published data with respect to clinical success, complications, and outcomes of endovascular stent-graft placement among patients with descending aortic dissection (AD). METHODS AND RESULTS: We performed a meta-analysis of all published series on retrograde endovascular stent-graft placement encompassing >or=3 patients with AD. Thirty-nine studies, involving a total of 609 patients, were included. Procedural success was reported in 98.2+/-0.5% of patients. Major complications were reported in 11.1+/-1.4%, with the most dreaded neurologic complications in 2.9+/-0.7% patients. Periprocedural stroke was encountered more frequently than paraplegia (1.9+/-0.6% vs. 0.8+/-0.4%). Overall complications were significantly higher in patients undergoing stent-graft placement for acute AD than in patients with chronic AD (21.7+/-2.8% vs. 9.1+/-2.3%, P=0.005). The overall 30-day mortality was 5.3+/-0.9%, and was three-fold higher in patients with acute AD when compared with chronic AD (9.8+/-2.2% vs. 3.2+/-1.4%, P=0.015). In addition, 2.8+/-0.7% of patients died over a mean follow-up period of 19.5+/-7.1 months. Kaplan-Meier analysis yielded overall survival rates of 90.6+/-1.6% at 6 months, 89.9+/-1.7% at 1 year, and 88.8+/-1.9% at 2 years, respectively. CONCLUSION: Endovascular stent-graft placement in type B-AD is technically feasible with success rates of >95% in selected cohort. Although minimally invasive, major complications occurred in 14-18% of patients depending upon the acuity of presentation, with very low incidence of paraplegia. Both, acute and mid-term mortality of this novel treatment strategy appear to favourably compare with surgical treatment but further studies are necessary to compare stent-graft placement with medical treatment in uncomplicated AD.     

Endovascular stent-graft for type B aortic dissection in elderly patients

Objective To report the clinical outcome and complications ofendovascular stent-graft treatment for type B aortic dissection in elderly patients, as compared with younger patients in a single medical center. Methods From May 2002 to July 2008, endovascular stent-graft implantation was performed in 124 patients with type B aortic dissection at the Department of Cardiology, Shenyang Northern Hospital. Among them, 39 patients were 60 yrs or older （ranging ~om 68 to 81 years） while 85 patients were younger than 60 years old （ranging from 31 to 58 years）. Patients were followed up for a mean period of 26 months （ranging from 1 to 78 months）. Clinical data were analyzed between the two groups. Results Comparing with the younger group, the elderly group had higher prevalence of coronary artery disease （59.0% vs 24.7%, P=0.001）. There was no significant difference of complication rates between the 2 groups （38.5% vs 31.8%, P=0.54）. Kaplan-Meier analysis showed a similar 5-year survival rate（80.2% vs 89.6%; Log Rank, P=0.31） between the 2 groups. Conclusions Endovascular stent-graft implantation is safe and effective in the treatment of type B aortic dissection for both elderly and younger patients. The procedure-related complication rate seems independent of age .     

Endovascular stent-graft placement for complications of acute type B aortic dissection

PURPOSE OF REVIEW: To review the concepts and current clinical results of endovascular stent-graft placement for acute complicated type B aortic dissection. RECENT FINDINGS: The optimal treatment for patients with dissections confined to the descending aorta (Stanford type B-AD) remains a matter of debate. Usually, antihypertensive medical therapy with strict blood pressure lowering below 135/80 mm Hg represents the first choice for patients with uncomplicated type B-AD. Patients with acute complicated type B-AD remain a major therapeutic challenge because surgery of the descending aorta is still associated with high morbidity and mortality. In 1999, endovascular stent-graft placement was introduced as a novel, less invasive treatment option for patients with type B aortic dissection. Current indications include acute (contained) aortic rupture, symptomatic ischemic branch vessel involvement, early aortic expansion, or unrelenting pain. So far, few studies on stent-graft placement in patients with acute complicated aortic dissection have been published reporting an early mortality between 0 and approximately 20%. SUMMARY: To date, there is limited experience with endovascular stent-graft placement for acute complicated type B aortic dissection demonstrating its feasibility and life-saving potential. The endovascular approach can avoid the major trauma of open surgery and should help to get patients out of the acute life-threatening phase of the disease; however, long-term results are needed to assess the durability of this treatment.     

Endovascular stent-graft repair of acute thoracic aortic dissection--early clinical experiences

BACKGROUND: Standard treatment of acute thoracic aortic dissection type B is the medical therapy used for most patients, according to Stanford. Surgical therapy involves a high mortality rate and is reserved for patients with complicated dissections. We report from four patients with acute thoracic aortic dissection, treated endoluminally by stent-graft implantation. METHODS: Four patients with complicated acute thoracic aortic dissections type B were treated endoluminally by transfemoral stent-graft implantation. Preoperative evaluation was performed with spiral-computed tomography and calibrated aortography. The Talent stent-graft system (Metronic) was used in all patients. RESULTS: The primary entry tear could be sealed successfully and complete thrombosis of the false thoracic aortic lumen was obtained in all cases. In one patient, transposition of the left subclavian artery was performed, in two patients the stent-grafts had to be placed across the origin of the left subclavian artery. No severe intra- or postoperative complications occurred. CONCLUSION: Endoluminal treatment of acute thoracic aortic dissection seems to be a less invasive and effective therapy. Long-term results for this method are necessary.     

Endovascular stent-graft treatment of aortic dissection: determinants of post-interventional outcome.

AIMS: To investigate the results of endovascular stent-graft placement for the treatment of patients with type B aortic dissection (B-AD). METHODS AND RESULTS: A total of 38 patients (62+/-10 years, 32 male) with acute (n=10) and chronic (n=28) type B-AD were treated with endovascular stent-grafts. The implantation procedure was successful in all patients. Peri-procedural non-fatal complications occurred in four (11%) patients. Overall, 4/38 (11%) patients died during the in-hospital period. Patients undergoing stent-graft placement for acute AD had a significantly higher in-hospital mortality than patients with chronic AD (40 vs. 0%, P=0.001). During a median follow-up of 18 (1-57) months, there were six additional deaths. Overall survival rates were 97.4+/-2.6% at 30 days, 80.4+/-6.7% at 1 year, 73.2+/-7.8% at 2 years, and 54.9+/-16.9% at 4 years. Patients with a poor clinical health status (ASA class > 3) had a significantly reduced life expectancy compared with patients with only moderate co-morbidities (ASA class 3) pre-operatively (HR=29.5, 95% CI 1.5-581.9, P=0.026) and increased age (HR=1.1, 95% CI 0.9-1.2, P=0.084) were independent determinants of post-interventional mortality. CONCLUSION: Endovascular stent-graft treatment is a safe alternative for patients with AD. The pre-operative clinical health status of the patient is the most important determinant of post-interventional outcome. Careful patient selection is thus of particular importance.     

Type A dissection following endovascular thoracic aortic stent-graft repair.

PURPOSE: To describe our experience with endovascular stent-graft repairs in the thoracic aorta focusing on the secondary complication of type A dissection. METHODS: Between January 1996 and April 2004, 73 patients were treated for traumatic thoracic aortic rupture (n=15), type B dissection (n=22), or atherosclerotic descending thoracic aortic aneurysms (TAA, n=36). A retrospective review of the records found 5 (6.8%) patients (3 men; median age 64 years, range 43-87) who experienced a type A dissection at a median 20 days (range 2-124) after thoracic stent-graft repair for 3 type B dissections, 1 TAA, and a late type I endoleak that appeared 28 months after initial stent-graft repair of a traumatic dissection. RESULTS: In 3 patients (2 dissections, 1 endoleak), a tear in the aortic wall at the proximal stent-graft was responsible for a retrograde type A dissection. Underlying disease was the cause of the type A dissection in the 2 other patients (1 dissection, 1 TAA) and was unrelated to the stent-grafts. Three patients underwent open surgery at 3, 26, and 124 days after stent-graft placement; 2 procedures were successful, but the third patient died 3 months later due to multiorgan failure. Two type A dissections were untreated: one patient died from cardiac tamponade 14 days after successful stent-graft exclusion of the type I endoleak; the other patient refused further treatment and survived. The procedure-related mortality following acute retrograde type A dissection was 40%. CONCLUSIONS: Endovascular stent-graft repair of the thoracic aorta is associated with lower morbidity and mortality rates than surgical repair, although potentially lethal complications, acute or delayed, may occur.     

应用腔内隔绝术治疗胸腹主动脉夹层及随访

目的:总结应用腔内隔绝术治疗Stanford B型主动脉夹层经验并报道中期随访结果。方法:22例急性和2例慢性Stanford B型主动脉夹层患者接受腔内隔绝术治疗,术后1、6、12个月,以后每年随访胸部X线平片与螺旋CT检查。结果:24例患者中23例技术成功,1例因支架故障技术失败,技术成功率95·8%。临床随访:23例技术成功患者中22例假腔内完全血栓形成,1例患者部分血栓形成,1例术后1周死于脑栓塞,1例术后3个月囊性动脉瘤形成需行外科血管置换术。临床成功率87·5%。结论:腔内隔绝术治疗急慢性胸腹主动脉夹层技术可行,中期疗效满意,远期疗效需要进一步随访观察。     

Endovascular stent-graft prosthesis in aortic aneurysm

Descending thoracic and abdominal aortic aneurysms represent a potential life-threatening situation. Resection and graft replacement of the pathologically altered aorta used to be the preferred method of treatment. Although progress has been achieved during the past decades in the management of patients with thoracic aortic aneurysms by new surgical techniques, intraoperative monitoring of somatosensory-evoked potentials, and spinal cord fluid drainage, postoperative morbidity and mortality rates still remain high. The afflicted population is usually of older age and present at the time of operation with various comorbidities such as hypertension, obstructive pulmonary disease, coronary heart disease, all of which with significant impact on surgical outcome. Postoperative complications, such as paraplegia, renal and pulmonary disease, contribute to prolonged hospital stay and higher medical cost. In this review we report on a promising alternative approach to the surgical treatment of thoracic and abdominal aortic aneurysms, namely the currently emerging utilization of the endovascular stent-graft prosthesis in both thoracic and abdominal aneurysm.     

主动脉腔内修复术治疗75例DeBakey Ⅲ型主动脉夹层

目的 总结主动脉腔内修复术(EVAR)治疗DeBakey Ⅲ型主动脉夹层适应证的选择、临床疗效以及探讨并发症的防治原则.方法 2002年12月至2007年6月采用TALENT带膜支架施行EVAR治疗75例DeBakeyⅢ型主动脉夹层患者,男65例,女10例,平均年龄54.4±12.6(29～83)岁.1例29岁女性病因考虑为埃-当综合征,2例年青男性分别继发于原发性醛固酮增多症和外伤车祸.全部患者均经螺旋CT或磁共振血管造影检查确诊.全身麻醉下经股动脉置入带膜血管内支架,封堵原发破口,重复造影检查.结果 75例患者共置入81枚带膜支架.其中2例因近端破口接近左锁骨下动脉,先行颈总动脉-锁骨下动脉旁路移植术,再置入支架,支架近段覆盖左锁骨下动脉.25例支架置入后出现明显内漏,20例予球囊扩张,6例置入1枚短支架后内漏消失.支架置入技术成功率为100％.1例埃-当综合征女性患者术中出现股动脉、髂外动脉、髂总动脉广泛血管撕裂,失血性休克,经抢救好转恢复.2例术后早期死于夹层破裂.术后随访1～24个月,2例(包括1例埃-当综合征患者)术后半年发生猝死,1例术后1年复查CT发现支架远端出现破口,经外科手术治疗后恢复良好;其余存活者复查螺旋CT示假腔径缩小并见腔内血栓形成,真腔径增大,无瘤体破裂、内漏及支架移位等并发症发生.结论 EVAR治疗DeBakeyⅢ型主动脉夹层具有技术可靠、创伤小、术后恢复快、成功率高等优点,尤其适用于不能耐受传统开胸手术的老年高危患者.而对于年轻的主动脉夹层患者要注意排除埃-当综合征等遗传性疾病,用EVAR治疗埃-当综合征的血管并发症,目前尚未见报道,其手术并发症及疗效有待进一步观察.     

Endovascular stent-graft treatment of penetrating aortic ulcer

Penetrating aortic atherosclerotic ulcer is an underdiagnosed condition that presents high rates of morbidity and mortality. We report two cases of patients with severe chest pain, with no ischemic features, who underwent chest angiotomography and showed an ulceration of the aortic wall, with contrast penetration into the middle layer. Due to the failure of the medical treatment, the patients underwent percutaneous aortic stent implantation with complete resolution of symptoms.     

国产覆膜支架治疗Stanford B型主动脉夹层

目的评价国产主动脉覆膜支架治疗Stanford B型主动脉夹层患者的院内及中期临床疗效。方法应用国产覆膜支架行主动脉腔内隔绝术治疗B型主动脉夹层患者34例,经股动脉置入覆膜支架封堵胸主动脉破裂口,置入Aegis或Hercules国产支架后,造影检查证实疗效。术后平均随访(19±17)个月。结果34例手术均获成功。32例置入1枚支架,2例分别置入主体和短支架各1枚,平均支架直径(33.5±3.5)mm,平均支架长度(96.5±17.6)mm。1例术后2h死于夹层破裂。3例术后存在原发性内漏。2例肾功能不全。出院后随访,2例分别于术后5个月和9个月发生继发性内漏,1例1年时升主动脉再次发现夹层,1例6个月后发生截瘫,2例死亡。结论国产主动脉覆膜支架治疗Stanford B型主动脉夹层患者具有良好的临床疗效。     

带膜血管内支架置入治疗胸主动脉夹层

目的　总结带膜血管内支架置入治疗DebakeyⅢ型主动脉夹层临床经验。方法　胸主动脉夹层 4 9例 ,男 4 4例 ,女 5例 ,平均年龄 (5 1 6± 1 8)岁。经CT增强扫描或磁共振成像确诊。切开右或左侧股动脉置入带膜血管内支架 ,封堵原发破口。置入后重复造影检查。随访行胸部X线平片与电子束CT检查。结果　支架置入全部成功 ,术后即刻造影 4 0例无内漏 ,9例见少量内漏。降主动脉及腹主动脉真腔均明显扩大 ,远端降主动脉及分支供血均有不同程度的改善。 1例因支架置入位置过高 ,行外科升主动脉 左颈总动脉 左锁骨下动脉旁路移植术。 1例术后死于中毒性休克。术后随访 :降主动脉及腹主动脉真腔扩大 ,术后造影 9例有内漏者 ,无加重 ,4例患者近端夹层动脉瘤消失 ,余者夹层近端假腔内均有血栓形成。结论　带膜血管内支架置入治疗胸主动脉夹层近期疗效满意 ,远期疗效有待于进一步观察。     

Endovascular stent-graft implantation in acute traumatic aortic dissection with contained rupture and hemorrhagic shock

BACKGROUND: Traumatic dissections of the thoracic aorta with consecutive organ ischemia are emergencies with an enormously high mortality despite immediate surgical therapy. Successful therapy of a thoracic aortic aneurysm by percutaneous implantation of a stent graft prosthesis was first reported in 1994. In recent years endovascular methods have been used increasingly for the treatment of acute aortic syndromes. CASE REPORT: After a traffic accident, a 33 year old motorcycle rider was admitted to our emergency unit conscious with clinical signs of hemorrhagic shock. His lower extremities were pulseless and paraplegia of the legs had already developed. An immediate angio-CT scan demonstrated a contained rupture of the aortic wall with mediastinal hematoma caused by a dissection beginning in the aortic arch. In the cathlab the right femoral artery was exposed and an angiography was performed showing a complete interruption of aortic blood flow caused by the transection. Under angiographic control an endovascular self-expanding nitinolstent (Talent Stent Graft, Medtronic) was implanted into the descending aorta. After moderate balloon inflation at the proximal entry, the rupture was completely closed and perfusion was restituted. The further clinical course was complicated by rhabdomyolysis necessitating additional subtotal arm amputation. Spinal ischemia resulted in persisting paraplegia of the legs. CONCLUSION: An urgent treatment of a contained rupture of the descending aorta with consecutive organ ischemia by endovascular implantation of stent graft prosthesis is technically possible. Advantages are a less invasive procedure and rapid restitution of blood flow.     

血管腔内覆膜支架治疗胸主动脉夹层68例

目的探讨直筒型和分支型覆膜支架治疗急、慢性Stanford B型胸主动脉夹层的方法及效果。方法对天津胸科医院治疗68例Stanford B型胸主动脉夹层的临床资料作回顾性分析。结果使用直筒型覆膜支架52只,分支型覆膜支架22只,在不影响左上肢血流的前提下完全封堵动脉内膜破口,真腔血流恢复正常,近期疗效满意。结论使用覆膜支架腔内隔离术治疗Stanford B型胸主动脉夹层,符合其病理解剖特点,能很好的封闭内膜破口,具有创伤小、适应证宽、治疗效果确切、康复迅速等优点,为高龄高危患者提供了治疗机会。     

腔内隔绝术治疗Stanford B型主动脉夹层210例分析

目的评价腔内隔绝术治疗Stanford B型主动脉夹层的疗效和安全性。方法收集2002年4月至2010年10月于沈阳军区总医院行主动脉腔内隔绝术治疗Stanford B型主动脉夹层210例资料,年龄(53.4±11.1)岁。经股动脉切开置入覆膜支架封堵胸主动脉破裂口,置入后造影检查证实疗效;合并严重冠状动脉狭窄者于腔内隔绝术后3～7 d完成经皮冠状动脉介入治疗(PCI)。观察介入治疗的疗效。结果腔内隔绝术成功率100%,共置入208枚主体覆膜支架及13枚cuff支架。20例患者完全封闭左锁骨下动脉开口,无左上肢及脑供血不足症状。26例患者行PCI成功率100%,对32支靶血管共置入36枚冠状动脉支架,无出血、心肌梗死等并发症。患者术后平均随访(60±35)个月,随访率96.6%(201/208)。33例出现腔内隔绝术后综合征,13例术后有残余内漏,其中8例残余内漏于术后3个月自行封闭。术后半年,3例再发升主动脉夹层,1例发生截瘫。术后1年,1例发生迟发性内漏。行PCI患者无主要心脏不良事件发生。本组共死亡6例,其中与腔内隔绝术有关死亡4例,分别发生在术后1 h、术后5 d、出院后2 d、15 d,与腔内隔绝术无关死亡2例,分别问胃癌晚期和肺心病。结论腔内隔绝术治疗Stanford B型主动脉夹层近期及长期疗效好、并发症低。合并冠心病患者择期二次行PCI安全可行。     

Endovascular repair of acute type B aortic dissection: midterm results.

PURPOSE: To evaluate midterm results of endovascular stent-graft placement for acute Stanford type B dissection (TBD). METHODS: A retrospective review was conducted of 35 consecutive patients who were treated with stent-graft implantation for acute TBD between July 1996 and July 2007. Computed tomographic (CT) volumetric analysis of the true lumen (TL) and false lumen (FL) changes in 23 patients was performed, as well as evaluation of the influence of re-entry points and length of stent-graft coverage on volume changes. In addition, complications were evaluated. Follow-up was performed at 6 and 12 months and yearly thereafter. RESULTS: The technical success rate was 82.7%, and the 30-day mortality rate was 8.5%. Mean follow-up was 34 months. The overall survival rate at 5 years was 78.4%. Complications included retrograde type A dissections in 3 patients during the perioperative period and in 1 patient during midterm follow-up. In addition, 5 early and 3 late endoleaks were observed. Three patients were converted to open surgery and 2 needed secondary interventions. In the stented segment, stabilization of the aorta was achieved even during midterm follow-up, with a TL volume increase of 59% at 5 years and nearly stable FL volume. The segment from the distal end of the stent-graft to the celiac artery, however, showed unstable TL and FL volumes, with high standard deviations after the first postinterventional year and circumferential aneurysmal dilatation of the aorta immediately adjacent to the stent-graft in 5 patients. The abdominal aorta showed no substantial volume changes over time. The length of stent-graft coverage and the occurrence of re-entries greatly influenced FL volume changes distal to the stent-graft. CONCLUSION: Serious complications can occur during and after endovascular repair of TBD. Therefore, it should be reserved for high-risk patients.     

用腔内隔绝术治疗B型主动脉夹层动脉瘤46例

目的评价用主动脉夹层动脉瘤腔内隔绝术治疗StanfordB型主动脉夹层动脉瘤的近、中期临床疗效。方法2002年5月至2006年9月,行主动脉腔内隔绝术治疗B型主动脉夹层46例。其中男36例,女10例;年龄62±18岁。46例均经股动脉切开置入覆膜支架封堵胸主动脉破裂口,置入后造影检查证实疗效,术后随访1~52个月,平均17±16个月,分析其临床特点及疗效。结果住院期间及随访30d内无患者死亡;发生主动脉腔内隔绝术后综合征11例;2例患者左锁骨下动脉被封闭;5例发生内漏,术后3个月时其中4例内漏自行封闭。随访3个月时,所有患者内膜破裂口封闭,胸降主动脉和腹主动脉真腔扩大,假腔内血栓形成,支架位置、形态正常。术后半年1例发生截瘫,原因不明。术后1年1例出现迟发性内漏;1例升主动脉发现夹层,未行外科手术。随访期间3例死亡,4年生存率89.3%。结论用主动脉夹层动脉瘤腔内隔绝术治疗B型主动脉夹层动脉瘤的近、中期疗效满意。     

Endoluminal stent-graft stabilization for thoracic aortic dissection.

PURPOSE: To review our experience with thoracic endografting for type B aortic dissection using the TAG Endoprosthesis. METHODS: A retrospective analysis was performed of data collected prospectively from March 2000 to July 2004 under an investigational device exemption protocol for the TAG thoracic endograft. In this time period, 40 patients (29 women; mean age 67 years, range 39-91) were treated with this endograft for type B aortic dissection. RESULTS: Technical success was 95%. There was 1 (2.5%) perioperative death, and 1 (3%) endoleak was treated with an additional graft on postoperative day 2. Fifteen (38%) patients experienced postoperative complications, mainly renal or pulmonary, and 1 (3%) patient developed postoperative paraplegia that did not resolve. The 1-year survival was 85%. Follow-up computed tomography was available for 31 patients with an average 15-month follow-up. There was no significant change in size of the thoracic aorta in 22 patients; 8 aneurysmal segments were significantly reduced in size and 1 thoracic aortic aneurysm expanded. No thoracic aortic ruptures were seen in this series. CONCLUSIONS: These early results indicate type B thoracic aortic dissections can be treated with acceptable morbidity and mortality using endografts. Stent-graft repair of the thoracic aorta may decrease the incidence of thoracic aortic expansion and rupture.