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.

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.

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.

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.

Outcomes and aortic remodelling after proximal thoracic endovascular aortic repair of post type B aortic dissection thoracic aneurysm

VASA ◽  
2016 ◽  
Vol 45 (4) ◽  
pp. 331-336 ◽  
Author(s):  
Zhenyu Shi ◽  
Jun Yang ◽  
Weiguo Fu ◽  
Daqiao Guo ◽  
Xin Xu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
False Lumen ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Maximum Diameter ◽  
Thoracic Aneurysm ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Aortic Repair ◽  
Type B Dissection

Abstract. Background: The objective was to explore the outcomes and aortic remodelling after proximal thoracic endovascular aortic repair (TEVAR) in post type B aortic dissection thoracic aneurysm with a maximal diameter ≥ 5.5cm. Patients and methods: 34 cases of type B aortic dissection thoracic aneurysm undergoing proximal TEVAR (coverage of the primary entry and the aneurysm extent) from 2008 to 2013 were retrospectively reviewed with follow-up for at least 2 years. The primary endpoints were 30-day mortality and survival at 2 years. The secondary endpoints were major complication and re-intervention. The aortic remodelling was investigated by comparison of the maximum diameter of the aneurysm and the diameter of true and false lumen at the same level between baseline and 2 years after TEVAR. Besides, we also analysed the possible relevant factors of aortic remodelling including the course of dissection, the involvement of dissection, and the length and shape of the stent graft. Results: The 30 day mortality was 2.9 % (1/34). The paraplegia rate post-TEVAR was 2.9 % (1/34). Overall, 32 out of the 34 cases were followed-up for 24 - 79 months. At 2 years, the overall and aortic specific survival were 87.5 % and 90.3 % respectively. The two year freedom from re-intervention rate was 87.5 %. Compared to the preoperative data, maximum diameter of descending aorta at 2 years demonstrated a slight increase (65.4±14.1mm Vs 63.9±9.1mm), but without significance (P>0.05). Meanwhile, we noticed a significant increase of true lumen (P < 0.01) and decrease of false lumen (P < 0.01) at the same level. Relevant analysis showed that positive aortic remodelling of the maximum diameter was associated with chronic phase (≥ 90 days of dissection onset) (P < 0.05) and the application of 150 - 170mm stent grafts (P < 0.05). Conclusions: Proximal TEVAR of post type B dissection thoracic aneurysm had generally favourable short- and mid-term outcomes with low paraplegia rate. Besides, it can achieve a certain extent of aortic remodelling.

scholarly journals Old Solutions for New Troubles in Complications after Thoracic Endovascular Aortic Repair

2017 ◽  
Vol 06 (01) ◽  
pp. e25-e28
Author(s):  
German Fortunato ◽  
Guillermo Stöger ◽  
Ricardo Marenchino ◽  
Vadim Kotowicz
Keyword(s):  
Aortic Aneurysm ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Type B ◽  
Ascending Aortic Aneurysm ◽  
Endovascular Stent Graft ◽  
Aortic Repair ◽  
First Case ◽  
Type B Dissection

Background The authors present two cases with type B aortic dissection initially treated by endovascular stent graft who developed aortic complications posttreatment and required surgical treatment. Case Description A 50-year-old woman and a 65-year-old man underwent endovascular treatment for thoracic aortic aneurysm associated with type B dissection and —both of them evolved with endoleak type 1. The first case was related to aortobronchial fistula, and the second one was associated with ascending aortic aneurysm. An extra-anatomical ascending aorta-supraceliac aorta bypass grafting was decided due to the persistent leak. Conclusion Surgery is an excellent choice for complex complications after thoracic endovascular aortic repair with previous failed attempts of endovascular resolution.

Safety and Effectiveness of TEVAR in Native Proximal Landing Zone 2 for Chronic Type B Aortic Dissection in Patients With Genetic Aortic Syndrome

2021 ◽  
pp. 152660282110612
Author(s):  
Ahmed Eleshra ◽  
Giuseppe Panuccio ◽  
Konstantinos Spanos ◽  
Fiona Rohlffs ◽  
Yskert von Kodolitsch ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
False Lumen ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Chronic Type ◽  
Ehlers Danlos Syndrome ◽  
Landing Zone ◽  
Aortic Repair

Objectives The aim of this study is to report the safety and effectiveness of thoracic endovascular aortic repair (TEVAR) in a native proximal landing zone (PLZ) 2 for chronic type B aortic dissection (TBAD) patients with genetic aortic syndrome (GAS). Methods A retrospective review of a single center database to identify patients with GAS treated with TEVAR in native PLZ 2 for chronic TBAD and thoracic false lumen aneurysm between February 2012 and February 2018 was undertaken. Results In total, 31 patients with GAS (24 Marfan syndrome [MFS], 5 Loeys-Dietz syndrome [LDS], and 2 vascular Ehlers-Danlos syndrome [vEDS]) were treated by endovascular repair. Nineteen patients were treated by TEVAR as index procedures with 8 patients (5 females, mean age = 55, range = 36–79 years old) receiving TEVAR in native PLZ 2. Left subclavian artery (LSA) perfusion was preserved in all 8 patients: by left common carotid artery-LSA bypass in 6 patients, chimney stenting of the LSA in 1 patient, and partial coverage of LSA ostium in 1 patient. Technical success was achieved in all patients (100%). There was no 30 day mortality (0%). The 30 day morbidity (0%) was free from major complications. The median follow-up was 40 months (range = 7–79). One patient died due to non-aortic-related cause. Native PLZ 2 was free from complications in MFS patients (5/8). Two patients with LDS developed type Ia endoleak with aneurysmal progression. One patient was treated by proximal extension with a double inner branched arch stent-graft landing in the replaced ascending aorta. The other one was treated with frozen elephant trunk. Conclusion Thoracic endovascular aortic repair in native PLZ 2 was safe and effective with no early or midterm PLZ complications in patients with MFS with chronic TBAD in this limited series. Native PLZ 2 is not safe in patients with LDS and should only be used in emergencies as a bridging to open repair.

scholarly journals Thirty-day outcomes from the Society for Vascular Surgery Vascular Quality Initiative thoracic endovascular aortic repair for type B dissection project

2019 ◽  
Vol 69 (3) ◽  
pp. 680-691 ◽  
Author(s):  
Grace J. Wang ◽  
Richard P. Cambria ◽  
Joseph V. Lombardi ◽  
Ali Azizzadeh ◽  
Rodney A. White ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Type B ◽  
Aortic Repair ◽  
Type B Dissection

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.

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