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True-Lumen Collapse in Aortic Dissection ¹

Part II. Evaluation of Treatment Methods in Phantoms with Pulsatile Flow

¹ From the Division of Cardiovascular-Interventional Radiology, Stanford University Medical Center, Stanford Vascular Center, H-3647, 300 Pasteur Dr, Stanford, CA 94304-5105. Received November 30, 1998; revision requested January 21, 1999; revision received March 19; accepted May 6. Address reprint requests to M.D.D. (e-mail: mddake@leland.stanford.edu).

PURPOSE: To discover and evaluate the effective treatment methods to prevent or relieve true-lumen collapse in models of aortic dissection.

MATERIALS AND METHODS: Two phantoms were built to simulate type B aortic dissection. After true-lumen collapse was induced, experiments were conducted to evaluate the effectiveness of clinically relevant variables in relieving the collapse. Variables included entry-tear size, branch-vessel flow distribution, distal reentry communication between the true and false limbs, aortic fenestrations, and pump output. To test the effect of closing the entry tear, a stent-graft was deployed over the entry tear under physiologic conditions in a mock-flow loop. The difference in the effect of each variable on the prevention and relief of true-lumen collapse was also investigated.

RESULTS: It was more difficult to relieve true-lumen collapse than it was to prevent it. Placement of a stent-graft over the entry tear was the most effective method of relieving true-lumen collapse. Less-effective procedures included opening a false-lumen outflow branch and opening the distal reentry branch. Opening the fenestration-branch loops, meant to simulate the creation of artificial fenestrations in the intimal flap, did not relieve true-lumen collapse.

CONCLUSION: The definitive treatment for true-lumen collapse in aortic dissection is direct repair of the entry tear to decrease false-lumen inflow. Otherwise, increasing the false-lumen outflow and/or creating distal fenestrations between the true and false lumina distal to the level of the compromised aortic branch are less-effective alternatives.

Index terms: Aorta, dissection, 942.4124, 943.743, 981.743 • Aorta, flow dynamics • Aorta, grafts and prostheses, 942.1268 • Aorta, stenosis or obstruction, 943.743, 981.743 • Phantoms, 942.412, 943.743, 981.743

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True-Lumen Collapse in Aortic Dissection ¹: Part I. Evaluation of Causative Factors in Phantoms with Pulsatile Flow

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