TCTAP A-046 Thoracic Endovascular Aortic Repair for Acute Type A Intramural Hematoma

We present the case of a 48-year-old woman with an acute type A aortic dissection that was treated with thoracic endovascular aortic repair at our institution. The patient was found to have a focal type A dissection with pericardial effusion but no tamponade physiology and no involvement of the aortic valve or root. We elected to treat the patient's type A aortic dissection with an endovascular stent because of the patient's favorable anatomy and no evidence of neurologic deficits or signs of distal malperfusion. The patient was successfully treated with an abdominal aortic cuff deployed through the axillary artery. An axillary approach was necessary because of the short length of the delivery sheath preventing a transfemoral delivery. At 2-year follow-up, the patient remains free of complications with computed tomography scan revealing complete false lumen thrombosis and a stable endovascular repair. This report demonstrates a case of acute type A aortic dissection successfully treated using thoracic endovascular aortic repair and illustrates the utility of axillary cannulation for precise deployment of stent grafts in the ascending aorta.

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Type A aortic dissection after ‘zone 0’ thoracic endovascular aortic repair for type 1 hybrid aortic arch replacement of arch aneurysm

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa508 ◽

2020 ◽

Vol 2020 (12) ◽

Author(s):

Sung Joon Han ◽

Man-Shik Shim ◽

Woo Sik Han ◽

Hyun Jin Cho ◽

Min-Woong Kang ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Type A ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Type I ◽

Acute Type ◽

Type A Aortic Dissection ◽

Aortic Repair ◽

Arch Aneurysm

Abstract The recent rise in minimally invasive cardiovascular procedures is being accompanied by an increase in related complications. We report on an acute type A aortic dissection performed in an 82-year-old man 1 week after staged ‘zone 0’ hybrid thoracic endovascular aortic repair (TEVAR). Previously, the patient had undergone type I hybrid arch debranching and staged ‘zone 0’ TEVAR for an aortic arch aneurysm. ‘Zone 0’ TEVAR after type I hybrid debranching might increase the risk for aortic injury on the residual native aorta and should, therefore, be closely followed up to enable the early diagnosis of complications.

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Thoracic Endovascular Aortic Repair for Retrograde Type A Intramural Hematoma With Intimal Disruption in the Descending Aorta

Journal of Endovascular Therapy ◽

10.1177/15266028211061268 ◽

2021 ◽

pp. 152660282110612

Author(s):

Yingliang Wang ◽

Songlin Song ◽

Chen Zhou ◽

Wenying Zhu ◽

Jiacheng Liu ◽

...

Keyword(s):

Adverse Events ◽

Intramural Hematoma ◽

Type A ◽

Ascending Aorta ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Descending Aorta ◽

Aortic Repair ◽

Intimal Tear

Purpose: To evaluate the safety and efficacy of thoracic endovascular aortic repair (TEVAR) for retrograde type A intramural hematoma (IMH) with intimal disruption in the descending aorta and report our endovascular therapeutic experience. Materials and Methods: From January 2014 to October 2020, a total of 24 consecutive patients with retrograde type A IMH with intimal disruption (intimal tear or ulcer-like projection) in the descending aorta underwent TEVAR. The demographics, clinical characteristics, treatment details, imaging information, and follow-up results were reviewed. Results: Among all patients with retrograde type A IMH, 13 (54.2%) patients presented with ulcer-like projection and 11 (45.8%) with intimal tear (aortic dissection) in the descending aorta. Successful TEVAR was achieved in all patients. There was no 30-day mortality. During a mean follow-up of 37.5 months, 1 patient (4.2%) developed permanent paralysis, 1 patient (4.2%) underwent reintervention due to the expansion of the aorta distal to the stent resulting from the enlargement of distal intimal tear at the 2 month follow up, and no other adverse events were observed. The latest computed tomographic angiography images showed that the maximum diameter of the ascending aorta and descending aorta significantly decreased after TEVAR (both p<0.001), and the IMH/false lumen in the ascending aorta and the descending thoracic aorta were completely absorbed. Conclusion: Thoracic endovascular aortic repair for selected patients with retrograde type A intramural hematoma that presented with intimal disruption in the descending aorta is feasible and efficient, but close surveillance is needed to manage aortic-related adverse events.

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