STABILISE for Complicated Type B Dissection after 15 Months’ Follow Up: A Word of Caution

2021 ◽  
Author(s):  
Raphael Soler ◽  
Michel A. Bartoli ◽  
Philippe Amabile ◽  
Gabrielle Sarlon-Bartoli ◽  
Pierre-Édouard Magnan
Keyword(s):  
Type B ◽  
Type B Dissection

Outcomes of Thoracic Endovascular Aneurysm Repair (TEVAR) in Patients With Connective Tissue Disorders

2020 ◽  
Vol 54 (8) ◽  
pp. 676-680
Author(s):  
Khalil Qato ◽  
Allan Conway ◽  
Eileen Lu ◽  
Nhan Nguyen Tran ◽  
Gary Giangola ◽  
...  
Keyword(s):  
Connective Tissue ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Acute Type ◽  
Type B ◽  
Connective Tissue Disorders ◽  
Aortic Repair ◽  
Type B Dissection ◽  
Significant Difference

Objectives: Thoracic endovascular aortic repair (TEVAR) remains controversial in patients with connective tissue disorders given the concern for durability. We report on the largest series to date on outcomes of patients with thoracic aortic disease and connective tissue disorders treated with TEVAR. Methods: The Vascular Quality Initiative registry identified 12 207 patients treated with TEVAR from January 2010 to December 2018, including 102 with Marfans, Ehlers-Danlos, or Loey-Dietz syndrome. Outcomes were analyzed per the Society for Vascular Surgery reporting standards. Results: Median age was 50.6 years (interquartile range: 57.0-75.0), and 62 (60.7%) were male. Eighty-eight (86.3%) patients had Marfan, 9 (8.8%) had Ehlers-Danlos, and 5 (4.9%) had Loey-Dietz syndrome. Twenty-six (25.5%) patients were treated for degenerative aneurysmal disease and 76 (74.5%) patients for type B dissections (33 acute, 31 chronic). Most common indications for interventions in patients with type B dissection were pain (n = 41), aneurysmal degeneration (n = 16), and malperfusion (n = 8), with 3 patients who presented ruptured. There was no significant difference in perioperative complications between acute/chronic dissections and aneurysms ( P = .14). Percutaneous access was utilized in 61.7% of patients, with a 2.9% rate of arterial injury requiring reintervention. Follow-up data were available for 75 (73.3%) patients at a mean follow-up of 15.6 months. Overall mortality was 5.3%. There were 30 patients with follow-up endoleak data, and 8 (26.7%) endoleaks were identified. All endoleaks were in patients treated for acute type B dissection, and all resolved after a mean of 2.1 reinterventions. Three patients treated for acute Type B Aortic Dissection (TBAD) had retrograde dissections requiring intervention. Discussion: Thoracic endovascular aortic repair for patients with connective tissue disorders can be performed with low perioperative mortality, spinal cord ischemia, or Cerebrovascular Accident (CVA). On follow-up, acute type B aortic dissections represent a higher risk subgroup with increased rates of endoleak and retrograde dissection. Closer follow-up for these patients and early reintervention may be beneficial.

Clinical feasibility and angiographic follow-up of endovascular stent graft for type B dissection (Stantford)

2008 ◽  
Vol 9 (2) ◽  
pp. 104
Author(s):  
C Albernaz ◽  
R de Barros Wanderley ◽  
IK Abílio Nunes ◽  
RL Favero ◽  
LH Kanashiro ◽  
...  
Keyword(s):  
Stent Graft ◽  
Endovascular Stent ◽  
Type B ◽  
Endovascular Stent Graft ◽  
Type B Dissection

Maternal and fetal outcomes in pregnancies complicated by Marfan syndrome

Heart ◽  
2019 ◽  
Vol 105 (22) ◽  
pp. 1725-1731 ◽  
Author(s):  
Matthew Cauldwell ◽  
Philip J Steer ◽  
Stephanie L Curtis ◽  
Aarthi Mohan ◽  
Samuel Dockree ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Marfan Syndrome ◽  
Beta Blockers ◽  
Type B ◽  
Maternal Deaths ◽  
Type B Dissection ◽  
Maternal And Neonatal Outcomes ◽  
Preconception Counselling ◽  
Aortic Size

ObjectivesInformation to guide counselling and management for pregnancy in women with Marfan syndrome (MFS) is limited. We therefore conducted a UK multicentre study.MethodsRetrospective observational study of women with MFS delivering between January 1998 and March 2018 in 12 UK centres reporting data on maternal and neonatal outcomes.ResultsIn total, there were 258 pregnancies in 151 women with MFS (19 women had prior aortic root replacements), including 226 pregnancies ≥24 weeks (two sets of twins), 20 miscarriages and 12 pregnancy terminations. Excluding miscarriages and terminations, there were 221 live births in 139 women. Only 50% of women received preconception counselling. There were no deaths, but five women experienced aortic dissection (1.9%; one type A and four type B—one had a type B dissection at 12 weeks and subsequent termination of pregnancy). Five women required cardiac surgery postpartum. No predictors for aortic dissection could be identified. The babies of the 131 (65.8%) women taking beta-blockers were on average 316 g lighter (p<0.001). Caesarean section rates were high (50%), particularly in women with dilated aortic roots. In 55 women, echocardiographic aortic imaging was available prepregnancy and postpregnancy; there was a small but significant average increase in AoR size of 0.84 mm (Median follow-up 2.3 months)ConclusionThere were no maternal deaths, and the aortic dissection rate was 1.9% (mainly type B). There with no identifiable factors associated with aortic dissection in our cohort. Preconception counselling rates were low and need improvement. Aortic size measurements increased marginally following pregnancy.

scholarly journals Medium-Term Results of Treatment for Complicated Acute Type B Dissection: A Spanish Experience in a Single Centre

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Jesus Alvarez-Garcia ◽  
Stefan Stefanov Kiuri ◽  
Alvaro Fernandez Heredero ◽  
Andres Salazar Alvarez ◽  
Nieves Aleicel Concepcion Rodriguez ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Hypertensive Crisis ◽  
Type I ◽  
Acute Type ◽  
Type B ◽  
Medium Term ◽  
Results Of Treatment ◽  
Type B Dissection ◽  
Type I Endoleak

Objective. To analyze and evaluate medium-term results obtained in endovascular treatment of complicated type B dissection. Methods. Prospective registry and retrospective analysis of the dissections treated with endoprosthesis in 1998 and 2010. Comorbidity, clinical presentation, anatomical characteristics, and evolution were recorded. Actuarial analysis was conducted for survival, follow-up and survival free of endoleaks, and free of reintervention due to relapse and/or progression. Results. Eighteen (18) patients were treated (14 male : 4 female), with a median age of 53 years (range 29–80). Their main symptoms were acute pain in 16 cases and hypertensive crisis in 15. The indications were 10 dissections not controlled by medication, 4 aneurysm dissecans, 2 acute lower limb ischemias, and 2 Type A progressions. Median 1.7 devices were used (range 1–4). Coverage of left subclavian artery was required in 3 cases, and of subclavian and left carotid artery in other 2 cases. There was a 100% technical success. Median follow-up was 43.1 months (1.5–127 range). There were two deaths caused by multiorganic failure, early mortality of 0%, and hospital mortality of 11%. There was a case of Type I Endoleak and 5 cases which required a new intervention due to relapse and/or progression. Cumulative survival at 30 months was 88%; follow-up free of endoleaks at 36 months was 91%. Follow-up free of progression/relapse at 12 months was 88%. Conclusion. Endovascular treatment of complicated type B acute dissection is an effective therapy for this condition, with a low associated mortality and with acceptable survival.

Fate of the Dissected Thoraco-Abdominal Aorta Distal to TEVAR (Thoracic Endovascular Aortic Repair) for Complicated Acute and Subacute Type B Aortic Dissection

2021 ◽  
pp. 152660282110659
Author(s):  
Jowan Nassib ◽  
Kheira Hireche ◽  
Baris Ata Ozdemir ◽  
Pierre Alric ◽  
Ludovic Canaud
Keyword(s):  
Morphological Changes ◽  
False Lumen ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Type B ◽  
Descending Aorta ◽  
Aortic Repair ◽  
Aneurysmal Dilation ◽  
Type B Dissection

Purpose: This study assessed morphological changes in the aortic true and false lumens during follow-up of patients undergoing TEVAR (Thoracic Endovascular Aortic Repair) for complicated acute and subacute type B dissection. The study analyzes the effectiveness of TEVAR in preventing distal aneurysmal progression. Materials and Methods: All patients between 2009 and 2019 undergoing TEVAR for complicated acute and subacute type B dissection at the study institution were retrospectively reviewed. Maximal diameters were measured on the proximal descending aorta right below the left subclavian artery, thoraco-abdominal junction right above the celiac trunk, and infrarenal aortic right above the inferior mesenteric artery, pre-operatively and during follow-up, analyzing either expansion or shrinkage of true and false lumens at these 3 sites. Results: Forty-one patients were included. Thirty-day incidence of death, stroke, paraplegia, and visceral ischemia was, respectively, 8% (n = 4), 6% (n = 3), 2% (n = 1), and 2% (n = 1). Three patients (6%) died from intervention-related cause. Mortality was 17% (n = 8) during a mean follow-up of 54 months. One patient had aneurysmal dilation of the descending aorta needing additional coverage and only 2 (4%) developed thoraco-abdominal aneurysms requiring re-intervention. In the remaining patients, both significant expansion of the true lumen and shrinkage of false lumen were observed at all 3 sites. Conclusion: Proximal coverage of the main entry tear appears to prevent aneurysmal progression in most patients (96%). With such promising results, TEVAR should be considered as a first-line treatment in acute and subacute type B dissection.

scholarly journals Analysis of perioperative outcome and long-term survival rate of thoracic endovascular aortic repair in uncomplicated type B dissection: single-centre experience with 751 patients

2019 ◽  
Vol 56 (6) ◽  
pp. 1090-1096 ◽  
Author(s):  
Hui-Qiang Gao ◽  
Shang-Dong Xu ◽  
Chang-Wei Ren ◽  
Sheng Yang ◽  
Chao-Liang Liu ◽  
...  
Keyword(s):  
Survival Rates ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Type B ◽  
Term Survival ◽  
Long Term Survival ◽  
Aortic Repair ◽  
Type B Dissection

Abstract OBJECTIVES To study the perioperative outcomes and long-term survival rates in patients undergoing thoracic endovascular aortic repair (TEVAR) for uncomplicated type B dissection. METHODS A total of 751 patients with uncomplicated type B dissection who underwent TEVAR at our centre between May 2001 and December 2013 were retrospectively reviewed. The mean age of all patients (619 males and 132 females) was 52.8 ± 10.9 years. The follow-up period ranged from 1 to 170 months (median 70 months). RESULTS Five patients died during the perioperative period (mortality rate 0.7%). Four patients (0.5%) developed retrograde type A dissection. Two patients (0.3%) developed paraplegia and 1 patient developed incomplete paralysis (0.1%). There were no postoperative cerebral infarctions. The 5- and 10-year survival rates were 96.5% [95% confidence interval (CI) 95.0–98.0%] and 83.0% (95% CI 77.9–88.4%), respectively. The 5- and 10-year reintervention rates were 4.6% (95% CI 3.0–6.2%) and 7.9% (95% CI 5.3–10.5%), respectively. CONCLUSIONS Although the application of TEVAR for patients with uncomplicated dissection is still under debate, many patients who have undergone TEVAR have benefitted substantially from the treatment. Our data showed that TEVAR had low mortality and complication rates both in the short- and long-term follow-up periods. TEVAR may be considered as a first choice for patients with uncomplicated type B dissection.

Quality of life after acute type b dissection in the era of thoracic endovascular aortic repair

VASA ◽  
2010 ◽  
Vol 39 (3) ◽  
pp. 219-228 ◽  
Author(s):  
Dick ◽  
Hirzel ◽  
Immer ◽  
Hinder ◽  
Dai-Do ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Endovascular Aortic Repair ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Aortic Repair ◽  
Type B Dissection

Background: Conservative management of acute type B aortic dissection is currently being challenged by primary thoracic endovascular aortic repair. Aim was to assess outcome and quality of life after these different approaches using an adjusted standard population as benchmark. Patients and methods: Observational study of a prospectively collected (January 2000 to December 2005) consecutive series of 87 patients with acute type B aortic dissection. Patients were 63 ± 13 years old and 68 were men (78.2 %). Seventy-two were managed conservatively (83 %) and 15 invasively (12 by endovascular aortic repair). Follow-up was 36 ± 19 months. Endpoints were early and late morbidity and mortality, and long-term quality of life as assessed by the Short Form health survey questionnaire. Results: Patient cohorts were similar regarding age, risk profile and local disease. In the conservative cohort, four patients died during early (5.6 %) and eight during long-term follow-up (cumulative four years survival rate 79 %). Thirty-two patients needed secondary surgical management (44 %), i.e. delayed aortic repair (n = 11), or interventions on adjacent aortic sections or major branches (n = 21). In the surgical cohort no patient died, and no repeated interventions were necessary after the peri-operative period. Long-term quality of life scores were 100 (69-115) in conservatively and 94 (75-124) in invasively managed patients. Normal scores range from 85 to 115. Conclusions: Primary endovascular management of uncomplicated acute type B dissection is safe and leads to excellent long-term results, whereas secondary interventions were required with high incidence after initial conservative management. Long-term quality of life, however, returned to normal with any successful treatment strategy.

Clinical Utility of Magnetic Resonance Imaging in the Follow-up of Chronic Aortic Type B Dissection

2014 ◽  
Vol 23 (7) ◽  
pp. e157-e159 ◽  
Author(s):  
Andrew G. Sherrah ◽  
Michael P. Vallely ◽  
Stuart M. Grieve ◽  
Richmond W. Jeremy ◽  
Paul N. Hendel ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Utility ◽  
Type B ◽  
Resonance Imaging ◽  
Type B Dissection

Surgery for Type B Dissection Using a Short-Stented Elephant Trunk Procedure

2012 ◽  
Vol 15 (2) ◽  
pp. 79
Author(s):  
LiangXin Tian ◽  
RuiDong Qi ◽  
Qian Chang ◽  
CunTao Yu ◽  
JunMing Zhu ◽  
...  
Keyword(s):  
Thoracic Aorta ◽  
False Lumen ◽  
Type B ◽  
Descending Thoracic Aorta ◽  
True Lumen ◽  
Elephant Trunk ◽  
Suitable Alternative ◽  
Stent Grafting ◽  
Type B Dissection

<p><b>Background:</b> Stent grafting is a very important treatment for type B dissection. Some patients are unsuitable for endograft repair because of inadequate proximal and/or distal fixation zones. We reviewed our experience of proximal descending thoracic replacement combined with short-stented elephant trunk implantation for type B dissection for patients without adequate fixation zones for endografts.</p><p><b>Methods:</b> Twenty-one patients with type B dissection (10 acute, 11 chronic) underwent this procedure between August 2003 and December 2007. After replacement of the proximal descending thoracic aorta, a short-stented elephant trunk was implanted into the residual descending thoracic aorta. The residual false lumen was evaluated post-operatively using computed tomography (CT) scans.</p><p><b>Results:</b> There were no in-hospital deaths. One death was observed during a mean follow-up of 69 � 15 months. One patient with preoperative shock suffered paraparesis but recovered postoperatively. One patient had paraplegia and was lost to follow-up. Cerebral hemorrhage was observed in 1 patient, but he recovered. Thrombus obliteration of the false lumen around the stented elephant trunk was observed in 19 patients (95%) and at the diaphragmatic level in 17 patients (85%) during follow-up.</p><p><b>Conclusion:</b> Replacement of the proximal descending thoracic aorta combined with short-stented elephant trunk implantation was a suitable alternative for type B dissection for patients without adequate fixation zones for endografts (particularly for young subjects). This procedure allowed enlargement of the true lumen, re-establishment of the true lumen, induction of thrombosis of the false lumen, and shrinkage of the aorta. Injury to the spinal cord, however, was an intractable problem.</p>

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