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Endovascular Treatment of Aortic Type B Dissection and Penetrating Ulcer Using Commercially Available Stent-Grafts

J. Sailer1, P. Peloschek1, T. Rand1, M. Grabenwöger2, S. Thurnher1 and J. Lammer1

1 Department of Angiography and Interventional Radiology, University Clinic of Radiodiagnostics, General Hospital Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
2 Department of Cardio-Thoracic Surgery, University Clinic of Surgery, General Hospital Vienna, A-1090 Vienna, Austria.



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Fig. 1A. 71-year-old man with back pain. Angiogram of thoracic aorta shows type B dissection before interventional therapy with flow of contrast medium from true lumen (T) across entry tear into false lumen (F).

 


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Fig. 1B. 71-year-old man with back pain. Aortogram of thoracic aorta directly after placement of two overlapping GORE Thoracic EXCLUDER stent-grafts (W. L. Gore; Sunnyvale, CA) shows proximal and distal end of endoprostheses (arrows) and overlapping region. Only true lumen (T) is evident.

 


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Fig. 1C. 71-year-old man with back pain. Cross-sectional helical CT scan of thoracic aorta shows type B dissection with true lumen (T) and false lumen (F).

 


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Fig. 1D. 71-year-old man with back pain. Cross-sectional helical CT scan of thoracic aorta 1 month after stent-graft placement shows enlarged true lumen (T) and compressed and thrombosed false lumen (F).

 


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Fig. 1E. 71-year-old man with back pain. Cross-sectional helical CT scan of thoracic aorta 6 months after intervention shows (E) slight increase of false lumen (F) at level of tracheal carina and (F) heavy increase of false lumen (F) at level of distal end of endoprosthesis. T = true lumen.

 


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Fig. 1F. 71-year-old man with back pain. Cross-sectional helical CT scan of thoracic aorta 6 months after intervention shows (E) slight increase of false lumen (F) at level of tracheal carina and (F) heavy increase of false lumen (F) at level of distal end of endoprosthesis. T = true lumen.

 


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Fig. 1G. 71-year-old man with back pain. CT scans 7 months after E and F show retrograde spreading of dissection, with contrast medium in partial thrombosed false lumen (R). T = true lumen.

 


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Fig. 1H. 71-year-old man with back pain. CT scans 7 months after E and F show retrograde spreading of dissection, with contrast medium in partial thrombosed false lumen (R). T = true lumen.

 


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Fig. 2A. 52-year-old man with back pain. Aortogram shows penetrating ulcer of thoracic aorta (arrow)

 


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Fig. 2B. 52-year-old man with back pain. Aortogram shows complete exclusion of ulcer from arterial circulation after implantation of TALENT stent-graft (Medtronic; Sunrise, FL). Arrows indicate proximal and distal ends of vascular endoprosthesis.

 

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