SHU Chang 1, 2, FANG Kun 1, 2, LI Ming 1, 2, LI Xin 1, 2, WANG Tun 1, 2, CHANG Qian 3. Corresponding author: SHU Chang,

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1 Chinese Journal of General Surgery DOI: /j.issn SHU Chang 1, 2, FANG Kun 1, 2, LI Ming 1, 2, LI Xin 1, 2, WANG Tun 1, 2, CHANG Qian 3 (1. Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha , China; 2. Minimally Invasive Intervention and Surgical Treatment Center for Macrovascular Disease of Hunan Province, Changsha , China; 3. Department of Vascular Surgery, Fuwai Hospital of Chinese Academy of Medical Sciences, Beijing , China) Corresponding author: SHU Chang, changshu01@aliyun.com ABSTRACT Objective: To evaluate the clinical efficacy of endovascular repair for aortic dissection during third trimester of pregnancy and early postpartum. Methods: The clinical records of 4 patients with pregnancy-related type B aortic dissection who underwent , 22(12):

2 KEY WORDS endovascular stent-graft repair were retrospectively analyzed. Of the 4 patients, aortic dissection in 2 cases occurred at 37 weeks of pregnancy, in one case occurred at 2 hours after delivery, and in one case occurred during the early postpartum period; 3 cases were diagnosed with Marfan syndrome (MFS), and the cause in one case was unknown. All patients underwent thoracic endovascular aortic stent-graft repair, and the assistant procedures included balloon dilation of aortic coarctation and insertion of chimney stent-graft into the left common carotid artery. The patients were followed by regular CT angiography monitoring at 1 month, 3 and 6 months after operation. Results: No maternal or child death occurred during the perinatal and follow-up period. One fetus was delivered via vaginal delivery and the other 3 fetuses were delivered by caesarean section. The aortic stentgrafts were successfully implanted in all of the 4 patients, with complete coverage of the primary tear in all cases and intentional coverage of the left subclavian artery in 3 cases, and there were no cases of type I endoleak or stent migration. In one patient with the primary tear located at the opening of the left subclavian artery, the landing zone was extended to the aortic arch and a chimney stent-graft was synchronously inserted into the left common carotid artery, and type II endoleak devolped after operation, which disappeared within the 11-month period of follow-up. The average follow-up time was 17.5 months, during which time, all the newborns survived, and one of them had neonatal jaundice that disappeared 12 d after delivery. Conclusion: Endovascular stent-graft repair has demonstrable short- and mid-term efficacy in treatment of type B aortic dissection during late trimester of pregnancy and early postpartum period. However, the timing and indications for repair should be determined with integrated consideration of the period of pregnancy and the clinical status of the patients. Aneurysm, Dissecting; Aortic Aneurysm; Pregnancy Trimester, Third; Postpartum; Endovascular Therapy CLC number: R654.3 Document code: A DOI: /j.issn , 22(12):

3 Table 1the clinical and operative data of the 4 patients Table 2Clinical results and follow-up data of the patients , 22(12):

4 Figure 1Endovascular repair for aortic dissection at 37 weeks of pregnancy (case 1)A: Preoperative CTA showing the tear in the initial part of the descending aorta (triangle), with a mature fetus in the pelvic cavity (asterisk); B: Preoperative arteriography showing a large false lumen and compressed true lumen, and aortic stenosis (arrow)with a minimum diameter of 1.0 cm; C: Postoperative follow-up CTA showing the repaired dissection with on endoleak and stent migration , 22(12):

5 Figure 2Endovascular assistive techniques for postpartum aortic dissection (case 2)A: Preoperative CTA showing the primary tear close to opening of the left subclavian artery (asterisk); B: CTA showing the patency of the stent with type II endoleak caused by caused by a retrograde blood flow from the left subclavian artery (asterisk) 3 months after aortic stent and chimney stent implantation; C: CTA showing the endoleak disappeared spontaneously 11 month after operation, and the patency of stent in the left common carotid artery , 22(12):

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7 - - - Cite this article as: SHU C, FANG K, LI M, et al. Endovascular repair for aortic dissection during late pregnancy and early postpartum[ J]. Chin J Gen Surg, 2013, 22(12): DOI: /j.issn , 22(12):