Stent Graft Placement for Aneurysmal Degeneration After Long-Term Medical Therapy for Type B Aortic Dissection Results in Volumetric Gain of the True Lumen and False Lumen Regression

Purpose: To describe the use and 6-month outcomes of the octopus endograft technique to reconstruct renovisceral arteries arising from the false lumen (FL) of a type B aortic dissection after thoracic endovascular aortic repair (TEVAR). Case Report: A 46-year-old man post TEVAR for type B aortic dissection was admitted with persistent back pain and a rapidly expanding residual dissection. The celiac and left renal arteries arose from the FL and the superior mesenteric artery from both lumens, with the FL as its main supply. A 20% oversized Endurant stent-graft was deployed with the short limb just above the beginning of the dissection flap and the long limb in the aortic true lumen. A 120-mm-long Endurant extended limb was delivered antegradely via a conduit and deployed into the FL, with a 3-cm overlap with the short limb of the Endurant main body. The 3 renovisceral arteries were reconstructed by lining each with a series of Viabahn or Fluency stent-grafts whose proximal ends were subsequently placed parallel in the FL Endurant extended limb and dilated with kissing balloons. Imaging at 6 months showed an excluded FL, without stenosis or occlusion in the stent-graft or the renovisceral arteries. Conclusion: This case illustrates the successful use of the octopus endograft technique to reconstruct renovisceral arteries arising from a rapidly expanding FL in a post-TEVAR type B aortic dissection; the technique might be applicable in carefully selected patients.

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Abstract 6192: Endovascular Stent-Graft Repair of Type B Aortic Dissection: Intermediate to Long-Term Results

Circulation ◽

10.1161/circ.118.suppl_18.s_1078-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Ung Kim ◽

Seong-Jin Hong ◽

Jung-Sun Kim ◽

Young-Guk Ko ◽

Dong-hoon Choi ◽

...

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

False Lumen ◽

Type B ◽

Type B Aortic Dissection ◽

Endovascular Stent Graft ◽

Stent Graft Repair ◽

Endovascular Stent Graft Repair

The aim of this study is to assess mid- to long-term clinical results of the endovascular stent-graft repair in patients with type B aortic dissection. Retrospective analysis was done on 73 patients (average age: 55.6 ± 12.4) who underwent stent-graft repair at our center from June 1994 to December 2007. The indications of case selection were progression of dissection despite adequate medical treatment, dynamic obstruction, intractable pain, aortic diameter of 6cm or more, or continuous false lumen leakage in either acute or chronic presentation. Median follow-up duration was 43 months (5 ~ 97 months, 64.4 ± 38.8 months). There was an absence of immediate postprocedural mortality or paraplegia. Angiographic success, defined as immediate closure of entry site without any significant endoleak, was obtained in 67/73 (91.7%) patients. Clinical success, defined as the complete obliteration or complete thrombosis of the false lumen at follow-up, was achieved in 53/73 (72.6%) patients. 22/73 (30.1%) patients demonstrated complications such as persistent type I endoleak, false lumen flow patency at distal portion of stent-graft, and 5/73 (6.8%) patients such as type II endoleak. Among these endoleaks, 5 cases were progressed and 17 cases were remained unchanged. There were unintended left subclavian artery occlusion (1 case), transient acute renal failure (1 case), saccular aneurysm (5 cases) and stent-graft migration or torsion (2 cases) as complications. During medial follow-up 43 months, 4 patients (5.5%) were died. In conclusion, cIinical outcomes of stent-graft repair of type B aortic dissection were favorable and should be considered as a safe and effective treatment option of type B aortic dissection, particularly in patients with a high risk surgical mortality or mobility.

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A Computational Fluid Dynamics Study Pre- and Post-Stent Graft Placement in an Acute Type B Aortic Dissection

Vascular and Endovascular Surgery ◽

10.1177/1538574410389342 ◽

2010 ◽

Vol 45 (2) ◽

pp. 157-164 ◽

Cited By ~ 40

Author(s):

Christof Karmonik ◽

Jean Bismuth ◽

Mark G. Davies ◽

Dipan J. Shah ◽

Houssam K. Younes ◽

...

Keyword(s):

Fluid Dynamics ◽

Computational Fluid Dynamics ◽

Aortic Dissection ◽

Stent Graft ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection ◽

Graft Placement

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How to Exclude the Dilated False Lumen in Patients after a Type B Aortic Dissection? The Cork in the Bottleneck

Journal of Endovascular Therapy ◽

10.1177/152660280301000213 ◽

2003 ◽

Vol 10 (2) ◽

pp. 244-248 ◽

Cited By ~ 16

Author(s):

Maartje C. Loubert ◽

Victor P.M. van der Hulst ◽

Cees De Vries ◽

Kees Bloemendaal ◽

Anco C. Vahl

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

Case Reports ◽

False Lumen ◽

Type B ◽

Type B Aortic Dissection ◽

Type B Dissection ◽

Occluder Device ◽

Stent Graft Implantation ◽

Graft Implantation

Purpose: To report techniques for excluding the dilated false lumen associated with chronic type B aortic dissection following placement of a stent-graft in the true lumen. Case Reports: Two patients underwent stent-graft implantation for a dilated false lumen after chronic aortic dissection, but the false lumen was not excluded from the circulation by this procedure. The false lumen was obliterated in one case with Greenfield filters and detachable balloons placed above a renal artery orifice that was perfused via the false lumen. This acted like “a cork in the bottleneck” to block retrograde flow into the thoracic portion of the false lumen above the blockade. In the other patient, an occluder device was used as the “cork.” In both cases, a good result was obtained. The occluder device is preferred because deployment is more controllable. Conclusions: An occluder device may be used like a cork in a bottle to exclude the dilated false lumen in the thoracic aorta after a type B dissection.

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Satisfactory Long-term Outcomes of Thoracic Endovascular Aortic Repair With a Bare Stent for Acute Complicated Type B Aortic Dissections

Journal of Endovascular Therapy ◽

10.1177/1526602820966991 ◽

2020 ◽

pp. 152660282096699

Author(s):

Yaowang Lin ◽

Shaohong Dong ◽

Jianfan Luo ◽

Weijie Bei ◽

Qiyun Liu ◽

...

Keyword(s):

Stent Graft ◽

False Lumen ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Type B ◽

Stent Group ◽

True Lumen ◽

Aortic Remodeling

Purpose To compare the clinical outcomes after thoracic endovascular aortic repair (TEVAR) with a bare stent to those after TEVAR alone in patients with complicated acute type B aortic dissection (cATBAD). Materials and Methods A prospective, randomized trial was conducted at 2 medical centers in China between 2010 and 2013. Patients with cATBAD were randomly assigned to receive TEVAR with a bare stent (n=42) or TEVAR only (n=42). Patients were scheduled to undergo computed tomography angiography at 3, 6, and 12 months and then annually to 5 years. The primary endpoint was all-cause mortality at 5 years; secondary outcomes were a composite of complications (endoleak, stent-graft–induced new entry, aortic rupture, and secondary intervention) and aortic remodeling at 1 and 5 years. Results All-cause death occurred in 1 (2.4%) patient in the TEVAR with bare stent group (lung cancer) and 5 patients (11.9%) in the TEVAR group (4 aorta-related) during the 5-year follow-up (log-rank p=0.025). The 1- and 5-year rates of complications and secondary interventions did not differ between the groups. Patients in the TEVAR with bare stent group had higher increases in the thoracic true lumen diameter (19.7±3.6 vs 17.0±6.2 mm, p=0.018) and abdominal true lumen diameter (13.7±4.8 vs 7.2±6.1 mm, p<0.001) and a higher incidence of complete false lumen thrombosis (80.9% vs 47.6%, p=0.005) at the 1-year follow-up. However, no between-group differences in the changes of aortic remodeling parameters were observed between the 1- and 5-year follow-up periods. Conclusion The addition of a distal bare stent to a thoracic stent-graft during TEVAR was associated with significantly improved long-term survival in cATBAD patients vs TEVAR only, likely due to the prevention of true lumen collapse and improvement of complete false lumen thrombosis of the dissected aorta.

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Comment on “Endovascular Stent-graft Placement in Stanford Type B Aortic Dissection in China”

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2010.06.017 ◽

2010 ◽

Vol 40 (4) ◽

pp. 542

Author(s):

J. Xiong ◽

W. Guo ◽

X.P. Liu

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

Endovascular Stent ◽

Type B ◽

Type B Aortic Dissection ◽

Endovascular Stent Graft ◽

Graft Placement ◽

Stanford Type B

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IF15. Implantation of Proximal Thoracic Stent Graft and Distal Bare Stent Promotes True Lumen Expansion but Not Aortic Remodeling in Patients With Chronic Complicated Type B Aortic Dissection

Journal of Vascular Surgery ◽

10.1016/j.jvs.2017.03.077 ◽

2017 ◽

Vol 65 (6) ◽

pp. 38S-41S

Author(s):

I-Ming Chen ◽

Chun-Yang Huang ◽

Po-Lin Chen ◽

Chun-Che Shih

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

Type B ◽

Type B Aortic Dissection ◽

True Lumen ◽

Aortic Remodeling ◽

Thoracic Stent Graft

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Erratum

Journal of Endovascular Therapy ◽

10.1177/152660280701400501 ◽

2007 ◽

Vol 14 (5) ◽

pp. A-6-A-6

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

Type B ◽

Type B Aortic Dissection ◽

Graft Placement

In the December 2006 issue, Dr. Bünger, one of the co-authors of “Provisional Extension to Induce Complete Attachment After Stent-Graft Placement in Type B Aortic Dissection: The PETTICOAT Concept” (2006;13:738–746), has requested that his name appears as Carsten Michael Bünger, MD; his middle name did not appear in the original article. The electronic versions of the article in both HTML and PDF have been revised to reflect this correction.

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