Endovascular Treatment of Distal False Lumen Aneurysmal Expansion in Chronic Type B Aortic Dissection with True Lumen Occlusion

Objectives The aim of this study is to report the safety and effectiveness of thoracic endovascular aortic repair (TEVAR) in a native proximal landing zone (PLZ) 2 for chronic type B aortic dissection (TBAD) patients with genetic aortic syndrome (GAS). Methods A retrospective review of a single center database to identify patients with GAS treated with TEVAR in native PLZ 2 for chronic TBAD and thoracic false lumen aneurysm between February 2012 and February 2018 was undertaken. Results In total, 31 patients with GAS (24 Marfan syndrome [MFS], 5 Loeys-Dietz syndrome [LDS], and 2 vascular Ehlers-Danlos syndrome [vEDS]) were treated by endovascular repair. Nineteen patients were treated by TEVAR as index procedures with 8 patients (5 females, mean age = 55, range = 36–79 years old) receiving TEVAR in native PLZ 2. Left subclavian artery (LSA) perfusion was preserved in all 8 patients: by left common carotid artery-LSA bypass in 6 patients, chimney stenting of the LSA in 1 patient, and partial coverage of LSA ostium in 1 patient. Technical success was achieved in all patients (100%). There was no 30 day mortality (0%). The 30 day morbidity (0%) was free from major complications. The median follow-up was 40 months (range = 7–79). One patient died due to non-aortic-related cause. Native PLZ 2 was free from complications in MFS patients (5/8). Two patients with LDS developed type Ia endoleak with aneurysmal progression. One patient was treated by proximal extension with a double inner branched arch stent-graft landing in the replaced ascending aorta. The other one was treated with frozen elephant trunk. Conclusion Thoracic endovascular aortic repair in native PLZ 2 was safe and effective with no early or midterm PLZ complications in patients with MFS with chronic TBAD in this limited series. Native PLZ 2 is not safe in patients with LDS and should only be used in emergencies as a bridging to open repair.

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Flow Diversion: A Novel Technique In The Management Of Aneurysmal False Lumen In Chronic Type B Aortic Dissection

Annals of Vascular Surgery ◽

10.1016/j.avsg.2020.01.036 ◽

2020 ◽

Vol 63 ◽

pp. 10-11

Author(s):

Motahar Hosseini ◽

David N. Blitzer ◽

Anahita Ghazi ◽

Shahab Toursavadkohi

Keyword(s):

Aortic Dissection ◽

False Lumen ◽

Flow Diversion ◽

Type B ◽

Type B Aortic Dissection ◽

Chronic Type ◽

Novel Technique

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Thoracic endovascular repair for disseminated intravascular coagulation associated with chronic type B aortic dissection

Vascular ◽

10.1177/1708538120934575 ◽

2020 ◽

Vol 28 (6) ◽

pp. 705-707

Author(s):

Jumpei Yamamoto ◽

Arudo Hiraoka ◽

Hidenori Yoshitaka

Keyword(s):

Aortic Dissection ◽

Disseminated Intravascular Coagulation ◽

Endovascular Repair ◽

Rare Complication ◽

False Lumen ◽

Celiac Artery ◽

Type B ◽

Type B Aortic Dissection ◽

Chronic Type ◽

Intravascular Coagulation

Objectives Chronic disseminated intravascular coagulation is a rare complication of aortic dissection, and its optimal treatment remains controversial. Methods We present a 78-year-old man with repeated hemorrhagic events by disseminated intravascular coagulation due to chronic aortic dissection treated by thoracic endovascular aortic repair. Results Computed tomography angiography at three months revealed a completely thrombosed false lumen from the distal aortic arch to the descending aorta at the celiac artery level. Platelets and D-dimer levels remained stable, and the patient was doing well without hemorrhagic complications. Conclusions Endovascular repair was effective for disseminated intravascular coagulation due to chronic type B aortic dissection.

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PC014. Intercostal Coil Embolization to Induce False Lumen Thrombosis in Chronic Type B Aortic Dissection

Journal of Vascular Surgery ◽

10.1016/j.jvs.2019.04.300 ◽

2019 ◽

Vol 69 (6) ◽

pp. e207

Author(s):

Jeniann A. Yi ◽

Gregory A. Magee ◽

Mohammed Eldeiry ◽

T. Brett Reese ◽

David P. Kuwayama

Keyword(s):

Aortic Dissection ◽

Coil Embolization ◽

False Lumen ◽

Type B ◽

Type B Aortic Dissection ◽

Chronic Type

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Tear size and location impacts false lumen pressure in an ex vivo model of chronic type B aortic dissection

Journal of Vascular Surgery ◽

10.1016/j.jvs.2007.11.059 ◽

2008 ◽

Vol 47 (4) ◽

pp. 844-851 ◽

Cited By ~ 114

Author(s):

Thomas T. Tsai ◽

Marty S. Schlicht ◽

Khalil Khanafer ◽

Joseph L. Bull ◽

Doug T. Valassis ◽

...

Keyword(s):

Aortic Dissection ◽

Ex Vivo ◽

False Lumen ◽

Type B ◽

Type B Aortic Dissection ◽

Chronic Type ◽

Ex Vivo Model ◽

Tear Size

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Transfemoral Transcatheter Aortic Valve Implantation using a Long Sheath for Chronic Type B Aortic Dissection: A Case Report

10.22541/au.162281700.05784640/v1 ◽

2021 ◽

Author(s):

Masaki Tsuda ◽

Yasuyuki Egami ◽

Koji Yasumoto ◽

Naotaka Okamoto ◽

Yasuharu Matsunaga-Lee ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Dissection ◽

Transcatheter Aortic Valve Implantation ◽

False Lumen ◽

Type B ◽

Type B Aortic Dissection ◽

Chronic Type ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

A 79-year-old woman with a history of open heart surgery presented with severe aortic stenosis (AS). Computed tomography (CT) showed chronic type B aortic dissection (TBAD) between the distal aortic arch and the left common iliac artery. After careful consideration, we planned transfemoral (TF)-transcatheter aortic valve implantation (TAVI) using a 20-Fr long sheath to minimize contact with the false lumen of the aorta. TAVI was performed under general anesthesia, guided by transesophageal echocardiography (TEE). A transcatheter aortic valve was successfully implanted. TEE, immediately after valve implantation, showed no remarkable changes in the descending thoracic aorta. Repeated post-procedural CT examinations showed no obvious changes in the aorta. The patient was stable without sequelae at the 12-month follow-up. This case demonstrates that TF-TAVI using a long sheath under TEE guidance can be a treatment option for patients with severe AS and chronic TBAD.

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Aortic Geometric Alteration Associated With Acute Type B Aortic Dissection: Angulation, Tortuosity, and Arch Type

Frontiers in Physiology ◽

10.3389/fphys.2021.708651 ◽

2021 ◽

Vol 12 ◽

Author(s):

Likun Sun ◽

Jiehua Li ◽

Lunchang Wang ◽

Quanming Li ◽

Hao He ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

False Lumen ◽

Ascending Aorta ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection ◽

True Lumen ◽

Factors Associated ◽

Geometric Factors

Background: Acute type B aortic dissection is a highly serious aortic pathology. Aortic geometric parameters may be useful variables related to the occurrence of acute type B aortic dissection (aTBAD). The aim of the study is to delineate the alteration in aortic geometric parameters and analyze the specific geometric factors associated with aTBAD.Methods: The propensity score matching method was applied to control confounding factors. The aortic diameter, length, angulation, tortuosity, and type of aortic arch of the aTBAD and control group were retrospectively analyzed via three-dimensional computed tomography imaging created by the 3mensio software (version 10.0, Maastricht, The Netherlands). The geometric variables of true lumen and false lumen in the descending aorta were measured to estimate the severity of aortic dissection. Multivariable logistic regression models were used to investigate the significant and specific factors associated with aTBAD occurrence. The area under the receiver operating characteristic curve (AUC) was used to estimate the performance of the model.Results: After propensity score matching, 168 matched pairs of patients were selected. The ascending aorta and aortic arch diameters were dilated, and the ascending aorta and total aorta lengths were elongated in aTBAD group significantly (P < 0.001). The ascending aorta and aortic arch angulations in the aTBAD group were sharper than those of the controls (P = 0.01, P < 0.001, respectively). The aortic arch and total aorta tortuosities were significantly higher in the aTBAD group (P = 0.001, P < 0.001, respectively). There were more type III arch patients in the aTBAD group than the controls (67.9 vs. 22.6%). The true lumen angulation was sharper than that in the false lumen (P < 0.01). The true lumen tortuosity was significantly lower than that in the false lumen (P < 0.001). The multivariable models identified that aortic arch angulation, tortuosity, and type III arch were independent and specific geometric factors associated with aTBAD occurrence. The AUC of the multivariable models 1, 2, 3 were 0.945, 0.953, and 0.96, respectively.Conclusions: The sharper angulation and higher tortuosity of aortic arch and type III arch were the geometric factors associated with aTBAD in addition to the ascending aorta elongation and aortic arch dilation. The angulation and tortuosity of the true and false lumens may carry significant clinical implications for the treatment and prognosis of aTBAD.

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Treatment of Acute Stanford Type B Aortic Dissection With a Novel Cylindrical Balloon Catheter in Dogs

Circulation ◽

10.1161/circ.102.suppl_3.iii-259 ◽

2000 ◽

Vol 102 (suppl_3) ◽

Author(s):

Hiromu Terai ◽

Nobushige Tamura ◽

Tatsuo Nakamura ◽

Kazunobu Nishimura ◽

Norimasa Tsutsui ◽

...

Keyword(s):

Blood Flow ◽

Aortic Dissection ◽

Balloon Catheter ◽

False Lumen ◽

Aortic Blood Flow ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection ◽

True Lumen ◽

Descending Aorta

Background —Despite recent progress in medical and surgical treatment, acute type B aortic dissection still carries a high mortality rate. We have developed a novel cylindrical balloon catheter for less invasive treatment to block the entry of the dissection and induce thrombotic occlusion of the false lumen. The balloon has the shape of a sheet when deflated but a double-cylinder shape when inflated. Therefore, aortic blood flow is maintained through the cylindrical lumen during balloon inflation. Methods and Results —Six beagle dogs underwent a left thoracotomy at the 6th intercostal space. An acute dissection of 4-cm length was created surgically on the descending aorta. The balloon catheter was inserted through the distal descending aorta and advanced to the entry site. The balloon catheter was inflated for 6 hours. The blood flow in the descending aorta and the position of the balloon was monitored by color Doppler echovasculography. Four dogs were killed humanely on the following day and 2 dogs 10 days after the surgery. The descending aorta was examined macroscopically and microscopically in all dogs. In all dogs, the false lumen was occluded by thrombi. Although no dog had clinical evidence of distal thromboembolism, 2 of the 4 dogs that were killed on the second postoperative day had fresh mural thrombi in the true lumen. Conclusions —The false lumen of the acute type B aortic dissection was effectively occluded by the novel cylindrical balloon catheter in the canine experimental model. The thrombus formation in the true lumen is the problem to be solved.

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