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

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.

scholarly journals Aortic remodelling after thoracic endovascular aortic repair in acute and chronic type B aortic dissections

2020 ◽  
Vol 58 (4) ◽  
pp. 730-737
Author(s):  
Daniel-Sebastian Dohle ◽  
Travis Laverne ◽  
Joseph Bavaria ◽  
Danielle Savino ◽  
Prashant Vallabhajosyula ◽  
...  
Keyword(s):  
Stent Graft ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
First Year ◽  
Type B ◽  
True Lumen ◽  
Coeliac Trunk ◽  
Aortic Dissections ◽  
Thrombosis Rate

Abstract OBJECTIVES Type B aortic dissections are routinely treated with thoracic endovascular aortic repair (TEVAR). The timing for TEVAR remains controversial and might have an impact on the remodelling capacity of the aorta. This study analyses and compares aortic remodelling in acute (ABD) and chronic (CBD) type B aortic dissections after TEVAR. METHODS This retrospective study analysed the preoperative, postoperative and at least 1-year follow-up computed tomography of 53 TEVAR patients (36 ABD, 17 CBD) at a single institution between May 2005 and May 2016. The volumes of aortic lumen (AL), true lumen, false lumen (FL) and perfused FL were measured at the stent graft level (A), from the stent graft to the coeliac trunk (B) and from the coeliac trunk to the bifurcation (C). The absolute volumes, normalized volume changes and FL thrombosis rate of ABD and CBD patients were compared. RESULTS Absolute AL and FL of segment A were significantly larger in CBD patients compared to ABD patients preoperatively (AL: 354 ± 68 vs 255 ± 51 ml, P = 0.023, FL: 253 ± 56 vs 183 ± 35 ml, P = 0.028) until last follow-up (AL: 462 ± 52 vs 246 ± 52 ml, P = 0.003, FL: 268 ± 202 vs 91 ± 31 ml, P = 0.004). The true lumen in segment A increased more in ABD than in CBD patients preoperatively to postoperatively (112% vs 36% P &lt; 0.001) and within the first year postoperatively (171% vs 80% P &lt; 0.001). FL in segment A decreased more in ABD compared to CBD patients within the first year (−42% vs −13% P &lt; 0.001) and thereafter (−50% vs +6% P = 0.002). In segments B and C, the FL thrombosis rate was higher in ABD than in CBD patients at all time points and significantly higher in segment A after the first year (91% vs 98% P = 0.035). CONCLUSIONS Aortic remodelling after TEVAR is significantly different in acute and chronic dissection patients. TEVAR promotes aortic remodelling in both acute and chronic dissections in terms of true lumen increase at stent graft level. Nevertheless, significant AL reduction by FL shrinkage is primarily found in ABD.

scholarly journals Mid-Term Clinical and Morphological Outcomes After Thoracic Endovascular Aortic Repair for Complicated Type B Aortic Dissection

2020 ◽  
pp. 1-7
Author(s):  
Hesong Zeng ◽  
Zakarya Ahmed ◽  
Xingwei He ◽  
Saddam Shaiea ◽  
Hesong Zeng
Keyword(s):  
Aortic Dissection ◽  
Success Rate ◽  
Abdominal Aorta ◽  
False Lumen ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Type B ◽  
Type B Aortic Dissection ◽  
True Lumen

Background: Complicated type B aortic dissections require surgery or thoracic endovascular aortic repair (TEVAR). In this study, we sought to explore the early and mid-term clinical efficacy of TEVAR treatment for Stanford complicated type B aortic dissection. Methods: From January 2012 to October 2017, the medical records and the aortic imaging data of 172 consecutive patients treated by TEVAR were retrospectively reviewed for statistical analysis. Aortic remodeling was evaluated based on the preoperative and one-year postoperative followed-up aortic CTA scan results. We analysed the diameters of the total aortic lumens, True and False lumens diameter and the thrombosis status at different five levels along the descending aorta. Results: The primary technical success rate was 97%, and the clinical success rate was 94.8%. At 1-year of aortic CTA follow-up after TEVAR, the true lumen diameter at the stented descending thoracic aorta increased significantly, the false lumen diameter significantly reduced. The remodeling process was stable with mild changes of true lumen increase and false lumen reduction at the unstented distal part of the descending thoracic and the abdominal aorta. Conclusion: This study confirmed that TEVAR treatment for complicated type B aortic dissection has a low mortality rate of mid-term follow-up outcomes. TEVAR stabilizes the size of the aorta and precipitates in FL thrombosis. However, FL in the abdominal aorta still patented and must be carefully observed for further long-term events.

High Wall Stress May Predict the Formation of Stent-Graft–Induced New Entries After Thoracic Endovascular Aortic Repair

2018 ◽  
Vol 25 (5) ◽  
pp. 571-577 ◽  
Author(s):  
Claudia Menichini ◽  
Selene Pirola ◽  
Baolei Guo ◽  
Weiguo Fu ◽  
Zhihui Dong ◽  
...  
Keyword(s):  
Stent Graft ◽  
Large Population ◽  
False Lumen ◽  
Wall Stress ◽  
Ct Images ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair ◽  
Type B Dissection

Purpose: To explore the potential role of morphological factors and wall stress in the formation of stent-graft–induced new entries (SINE) based on computed tomography (CT) images after thoracic endovascular aortic repair (TEVAR). Case Report: Two female patients aged 59 years (patient 1) and 44 years (patient 2) underwent TEVAR for type B dissection in the chronic (patient 1) or subacute (patient 2) phase. CT scans at 3-month follow-up showed varying degrees of false lumen thrombosis in both patients. At 14-month follow-up, a SINE was observed in patient 1 while the dissected aorta in the other patient remained stable. Morphological and finite element analyses were performed based on the first follow-up CT images. The computational results showed that the SINE patient had higher stent-graft tortuosity than the non-SINE patient and much higher wall stress in the region close to the distal SINE. Conclusion: This case study suggests that high stent-graft tortuosity can lead to high wall stress, which is potentially linked to the formation of SINE. Further large population-based studies are needed to confirm this preliminary finding.

Preoperative proteinuria and clinical outcomes in type B aortic dissection after thoracic endovascular aortic repair

2019 ◽  
Vol 57 (5) ◽  
pp. 752-758
Author(s):  
Hongwei Yang ◽  
Jianwei Zhou ◽  
Keli Huang ◽  
Tao Yu ◽  
Zuhui Wang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Clinical Outcomes ◽  
Multivariate Logistic Regression Analysis ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Type B ◽  
Urine Dipstick ◽  
Aortic Repair

Abstract Background Proteinuria is a marker of poor outcomes in several diseases; however, few studies have been conducted to explore the prognostic value of proteinuria, assessed by urine dipstick test, for clinical outcomes in patients with type B acute aortic dissection (TBAD) undergoing thoracic endovascular aortic repair (TEVAR). Methods Consecutive patients with TBAD undergoing TEVAR were enrolled from January 2010 to July 2015. Proteinuria was defined as trace or higher, according to the results of urine dipstick testing. Associations among proteinuria and adverse events were evaluated. Results In total, 671 patients with a mean age of 44±15 years were included in the analysis. Proteinuria was detected in 281 patients (41.9%) before TEVAR. Multivariate logistic regression analysis showed that C-reactive protein and impaired renal function were independent predictors for proteinuria. During hospitalization, 21 patients died. In-hospital mortality was higher in patients with proteinuria (1.5% vs. 5.3%, p=0.005). After a median 3.4 years follow up, the post-TEVAR death rate was 10.4% (85 patients were lost to follow-up). The long-term cumulative mortality was significantly higher in patients with proteinuria (17.2% vs. 8.2%, log-rank=11.36, p=0.001). Multivariate Cox survival modeling indicated that proteinuria was significantly associated with long-term death, after adjustment for potential confounding risk factors (HR=1.92, p=0.012). Conclusions Pre-TEVAR proteinuria was identified as a prognostic marker in patients with TBAD and has potential for application as a convenient and simple risk assessment method before TEVAR.

scholarly journals Description of a new technique for repairing chronic type B dissections that involve visceral branches being fed by both true and false lumen by using both lumens as conduits

Vascular ◽  
2015 ◽  
Vol 24 (1) ◽  
pp. 103-105 ◽  
Author(s):  
Joe Anderson ◽  
Tyler Remund ◽  
Katie Pohlson ◽  
Patrick Kelly
Keyword(s):  
False Lumen ◽  
Aortic Aneurysms ◽  
Type B ◽  
Stent Grafts ◽  
True Lumen ◽  
Chronic Type ◽  
Novel Technique ◽  
A New Technique

Here we present three cases performed using a novel technique where aortic flow is compartmentalized proximal to the target vessels through a physician-modified endograft. The visceral segment is then further compartmentalized by the use of another physician modified endograft. By compartmentalizing the flow proximal to the visceral segment, both the true lumen and false lumen can be used as conduits for coextensive bridging stent grafts. Overall, patients have tolerated this procedure extremely well, and while further study and follow-up must be conducted, this procedure could offer a reasonable long-term solution to thoracoabdominal aortic aneurysms complicated by dissection.

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.

Use of the Octopus Endograft Technique to Reconstruct Renovisceral Arteries Arising From the False Lumen of a Rapidly Expanding Type B Aortic Dissection After Endovascular Repair

2016 ◽  
Vol 24 (1) ◽  
pp. 107-111 ◽  
Author(s):  
Jiang Xiong ◽  
Yangyang Ge ◽  
Xiaoping Liu ◽  
Lijun Wang ◽  
Wei Guo
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
False Lumen ◽  
Thoracic Endovascular Aortic Repair ◽  
Main Body ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Stent Grafts ◽  
True Lumen ◽  
Short Limb

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.

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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