scholarly journals Outcome after acute und subacute TEVAR in uncomplicated type B aortic dissection

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
S Jungi ◽  
S Mylonas ◽  
M Ante ◽  
W Ahmad ◽  
K Meisenbacher ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
False Lumen ◽  
Aortic Diameter ◽  
Lumen Diameter ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Best Medical Therapy ◽  
One Year ◽  
Aortic Remodeling

Abstract Objective In the past years, a paradigm shift from best medical therapy to early thoracic endovascular aortic repair (TEVAR) has been observed in the treatment of uncomplicated type B aortic dissection (uTBAD). We aimed to analyze outcomes after TEVAR in the acute and subacute phase of uTBAD, focusing on aortic remodeling. Methods Retrospective analysis of consecutive patients who underwent TEVAR for acute or subacute uTBAD in two tertiary referral centers from 2008 – 2017. Two assessors per center reviewed computed tomography scans of each patient at presentation, at one year and at the last follow-up using post-processing software. Results Forty-nine patients were treated with TEVAR for uTBAD. The indication for TEVAR was the presence of multiple morphologic predictors of adverse aortic outcome. The most common predictors were a false lumen diameter of > = 22mm in 76% of patients, a primary entry tear of > = 10mm in 69% and a total aortic diameter of > = 40mm in 67%. There were no in-hospital deaths and no deaths at 1 year. The median follow-up was 40.6 months. Three-year cumulative survival was 94 % (46/49). Fourteen secondary interventions were performed in 10 patients (20 %) after a median of 4.2 months. TEVAR lead to remodeling of the descending thoracic aorta with a median reduction of the total aortic diameter of 4.5 mm within one year and stable diameters after three years. The median maximum false lumen diameter diminished from 26 mm to 15 mm in one year (at 3 years: 14.8 mm). Conclusion In this cohort of selected patients with uTBAD and multiple morphologic predictors of worse aortic outcome, elective acute or subacute TEVAR was associated with a low mortality and positive aortic remodeling in the mid-term follow-up.

Endovascular Repair of Acute Type B Aortic Dissection: Long-Term Follow-Up of True and False Lumen Diameter Changes

2007 ◽  
Vol 83 (3) ◽  
pp. 1059-1066 ◽  
Author(s):  
Maria Schoder ◽  
Martin Czerny ◽  
Manfred Cejna ◽  
Thomas Rand ◽  
Alfred Stadler ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Endovascular Repair ◽  
False Lumen ◽  
Lumen Diameter ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Long Term Follow Up

Management of a Compromised Frozen Elephant Trunk Due to Acute Type B Aortic Dissection

2020 ◽  
Vol 54 (8) ◽  
pp. 756-759
Author(s):  
Amer Harky ◽  
Robert K. Fisher ◽  
Mark L. Field
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
False Lumen ◽  
Acute Type ◽  
Type B ◽  
Frozen Elephant Trunk ◽  
Type B Aortic Dissection ◽  
Elephant Trunk ◽  
Thoracoabdominal Aorta

Purpose: To report a case who required a thoracic endovascular stenting (TEVAR) following the deployment of frozen elephant trunk due to false lumen expansion Case Report: A 47 years old male patient undergone emergency repair of acute type A aortic dissection in 2011 with bioprosthetic aortic root conduit. Seven years later he presented with moderate aortic valve disease and expanding chronic dissection of the aortic arch, therefore a redo operation with replacement of the prosthetic aortic valve, ascending aorta, total arch and deployment of frozen elephant trunk and he was discharged in good health. Several days post discharge he presented with new onset of chest pain and a new dissection involved the thoracoabdominal aorta was noted pressing on the true lumen and the frozen elephant trunk. Following a multi-disciplinary team meeting, TEVAR was deemed as a most appropriate approach and this was achieved successfully, and patient was discharged. At 1 year of follow up, he remains well and asymptomatic. Conclusion: Close imaging follow-up following deployment of a FET is mandatory. A new acute Type B aortic dissection distal to the FET, that causes false lumen propagation parallel to the stented portion, is a surgical emergency and further intervention mandated.

Morphologic predictors of aortic expansion in chronic type B aortic dissection

Vascular ◽  
2015 ◽  
Vol 24 (2) ◽  
pp. 187-193 ◽  
Author(s):  
D Kotelis ◽  
G Grebe ◽  
P Kraus ◽  
M Müller-Eschner ◽  
M Bischoff ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Dissection ◽  
Aortic Diameter ◽  
Aortic Dilatation ◽  
Type B ◽  
Type B Aortic Dissection ◽  
True Lumen ◽  
Cross Sectional ◽  
Aortic Dissections

Aim To identify morphologic factors affecting aortic expansion in patients with uncomplicated type B aortic dissections. Methods Computed tomography data of 24 patients (18 male; median age: 61 years), diagnosed with acute uncomplicated type B aortic dissections between 2002 and 2013, were retrospectively reviewed. All patients had at least two computed tomography angiography scans and six months of uneventful follow-up. Computed tomography scans were assessed by two independent readers with regard to presence and number of entry tears. Thoracic and abdominal aortic diameters were derived using image processing software. Results Twenty-two of 24 patients showed aortic expansion over a median computed tomography angiographic follow-up of 33.2 months. Annual rates showed an increase of 1.7 mm for total aortic diameter, 2.1 mm for the false and a decrease of −0.4 mm for the true lumen. In three patients (12.5%), aortic diameter exceeded 60 mm during follow-up, and all three patients underwent thoracic endovascular aortic repair. Patients with a maximum aortic diameter <4 cm at baseline showed a significantly higher expansion rate compared to cases with an initial maximum aortic diameter of ≥4 cm ( p=0.0471). A median of two entries (range: 1–5) was recognized per patient. Presence of more than two entry tears ( n = 13) was associated with faster overall diameter expansion (mean annual rates: 2.18 mm vs. 1.16 mm; p = 0.4556), and decrease of the cross-sectional surface of the true lumen over time (annual rate for > 2 entries vs. ≤2 entries: −7.8 mm2 vs. +37.5 mm2; p = 0.0369). Median size of entry tears was 12 mm (range: 2–53 mm). Conclusions The results presented herein suggest that uncomplicated type B aortic dissection patients with more than two entry tears and/or an initial maximum aortic diameter of<4 cm are at risk for aortic dilatation and, therefore, may require stricter follow-up including the possible need for early intervention.

scholarly journals Frequency of abdominal aortic expansion after thoracic endovascular repair of type B aortic dissection

Vascular ◽  
2016 ◽  
Vol 24 (6) ◽  
pp. 567-579 ◽  
Author(s):  
Tim F Weber ◽  
Dittmar Böckler ◽  
Matthias Müller-Eschner ◽  
Moritz Bischoff ◽  
Moritz Kronlage ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Aortic Dissection ◽  
False Lumen ◽  
Celiac Trunk ◽  
Thoracic Endovascular Aortic Repair ◽  
Infrarenal Aorta ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Abdominal Aortic

Purpose To determine abdominal aortic expansion after thoracic endovascular aortic repair (TEVAR) in patients with aortic dissection type B and 36 months minimum follow-up. Methods Retrospective study of 18 TEVAR patients with follow-up >36 months. Abdominal aortic diameters at celiac trunk (location B) and infrarenal aorta (location C) were recorded on the first and last imaging after TEVAR. False lumen thrombosis was determined at level of endograft (A) and at B and C. Aortic expansion was defined as diameter increase of 5 mm or 15%. Correlation analyses were performed to investigate potential determinants of expansion. Results Median follow-up was 75.2 months. Sixteen of 18 patients (88.9%) demonstrated abdominal expansion. Mean expansion was 9.9 ± 6.1 mm at B and 11.7 ± 6.5 mm at C, without a difference between acute and chronic dissections. Critical diameters of 55 mm were reached in two patients treated for chronic dissection (11.1%). Annual diameter increase was significantly greater at locations with baseline diameters >30 mm (2.1 ± 1.1 mm vs. 1.0 ± 0.6 mm, p = 0.009). Baseline diameters were greater in patients with chronic dissections. Conclusion Abdominal aortic expansion can be frequently recognized after TEVAR for aortic dissection type B and occurs independently from thoracic false lumen thrombosis. Clinical significant abdominal aortic expansion may occur more frequently in patients treated with TEVAR for chronic dissection.

scholarly journals Impact of initial aortic diameter and false-lumen area ratio on Type B aortic dissection prognosis†

2017 ◽  
Vol 26 (2) ◽  
pp. 176-182 ◽  
Author(s):  
Akihito Matsushita ◽  
Takashi Hattori ◽  
Yu Tsunoda ◽  
Yasunori Sato ◽  
Wahei Mihara
Keyword(s):  
Aortic Dissection ◽  
False Lumen ◽  
Area Ratio ◽  
Aortic Diameter ◽  
Lumen Area ◽  
Type B ◽  
Type B Aortic Dissection

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

Circulation ◽  
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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