Eur J Cardiothorac Surg 2002;21:768-769
© 2002 Elsevier Science NL
Reply to Urbanski
M. Totaro*,
F. Miraldi,
A.G.M. Marullo,
G. Mazzesi
Università "La Sapienza", II Divisione Cardiochirurgia, Viale del Policlinico 155, 00161 Rome, Italy
Received 21 December 2001;
received in revised form 9 January 2002;
accepted 10 January 2002.
* Corresponding author. Tel.: +39-06-49972410; fax: +39-06-49972410
e-mail: marcototaro{at}virgilio.it
We appreciate the letter by Urbanski and we congratulate him on the brilliant operation he performed. Anyhow, we think it is important to point out that in the case we reported the patient was treated immediately after the endovascular procedure and so there was an obvious direct link between the procedure and the complication. It is also important to point out the different location of the endoluminal stents in relation to the aortic arch vessels take off and, in fact, in our case [1] the stent was covering the origin of the left subclavian artery (Fig. 1) , while in Urbanski's case the proximal edge of the endoluminal prosthesis was much lower and distant from the left subclavian artery as demonstrated by the computed tomography [2].
We decided to manage the operation without trying to displace the stent, the only way to perform an elephant trunk operation, because we considered this manoeuvre as an incremental risk factor not corresponding to the mandatory goal of saving the patient's life.
In conclusion, we agree that type A retrograde dissection after endovascular treatment of type B is possible either early or late, but the surgical treatment is depending crucially on the anatomical location of the endovascular stent in relation to the descending thoracic aorta and aortic arch. In the near future, it is desirable that further evolution of endovascular prostheses will allow to perform direct anastomoses on those stents cutting off completely the diseased aorta.
References
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Totaro M., Miraldi F., Fanelli F., Mazzesi G. Emergency surgery for retrograde extension of type B dissection after endovascular stent graft repair. Eur J Cardiothorac Surg 2001;20:1057-1058.[Abstract/Free Full Text]
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Urbanski P. Retrograde extension of type B dissection after endovascular stent graft repair. Eur J Cardiothorac Surg 2002;21(4):767.[Free Full Text]
