Pregnancy-associated type B aortic dissection treated with thoracic endovascular aneurysm repair.

BACKGROUND: The purpose of this study was to report our early experience with thoracic endovascular aneurysm repair as a treatment for late pregnancy-associated aortic dissection.

METHODS: We retrospectively reviewed the records and imaging data of 4 consecutive patients who were diagnosed with acute aortic dissection. All 4 patients were diagnosed during the third trimester or early postpartum period, and all of them were treated with thoracic endovascular aneurysm repair either before or after delivery; adjunctive endovascular procedures included balloon dilation of aortic coarctations and insertion of a snorkel stent into the left common carotid artery. All mothers and children were followed by outpatient observation; mothers had surveillance with computed tomography angiography at 1, 3, and 6 months and then yearly.

RESULTS: Technical success was 100%, with coverage of the primary tear sites in all 4 cases. The left subclavian artery was covered in 3 patients. During follow-up there were no type I endovascular leaks or stent migrations; type II endovascular leak was detected in 1 patient who required a left common carotid artery snorkel stent, and this endovascular leak disappeared at 11 months. All mothers and children survived the perinatal period and showed no major adverse outcomes during follow-up of 17.5 months.

CONCLUSIONS: Short and midterm results of thoracic endovascular aneurysm repair for complicated type B aortic dissection in late trimester and early postpartum period are satisfying in this series. Indications for and timing of procedure relative to delivery should be determined cautiously by clinical urgency.