True-lumen collapse in aortic dissection: part II. Evaluation of treatment methods in phantoms with pulsatile flow

Radiology. 2000 Jan;214(1):99-106. doi: 10.1148/radiology.214.1.r00ja3499.


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.

MeSH terms

  • Aortic Aneurysm / physiopathology
  • Aortic Aneurysm / therapy*
  • Aortic Dissection / physiopathology
  • Aortic Dissection / therapy*
  • Blood Vessel Prosthesis Implantation
  • Hemodynamics / physiology
  • Humans
  • Models, Cardiovascular*
  • Phantoms, Imaging*
  • Pulsatile Flow / physiology*
  • Stents
  • Treatment Outcome