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 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 &gt; = 22mm in 76% of patients, a primary entry tear of &gt; = 10mm in 69% and a total aortic diameter of &gt; = 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.

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.

Endovascular Therapy for Nonischemic vs Ischemic Complicated Acute Type B Aortic Dissection

2019 ◽  
Vol 27 (1) ◽  
pp. 145-152 ◽  
Author(s):  
Ahmed Eleshra ◽  
Tilo Kölbel ◽  
Giuseppe Panuccio ◽  
Fiona Rohlffs ◽  
E. Sebastian Debus ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Uncontrolled Hypertension ◽  
Aortic Dilatation ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Ischemic Group ◽  
Atherosclerotic Stenosis ◽  
Significant Difference ◽  
Branch Vessel

Purpose: To report a single-center experience with thoracic endovascular aortic repair (TEVAR) for complicated acute type B aortic dissection (cATBAD) comparing patients with vs without end-organ ischemia. Materials and Methods: Between November 2010 and December 2017, 64 patients (mean age 64.8±12.5 years; 49 men) underwent TEVAR for cATBAD. Patients were grouped into 2 cohorts: nonischemic (39, 61%) patients with unrelenting pain, early progressive aortic dilatation, uncontrolled hypertension, or rupture, and ischemic (25, 39%) patients with visceral, renal, lower extremity, or spinal cord hypoperfusion. Results: Mean time from diagnosis to treatment was 7.5 days (range 1–32) in the nonischemic group vs 2.3 days (range 1–14) days in the ischemic group (p=0.007). Fourteen (56%) of 25 ischemic cATBAD patients had stents implanted in the renovascular branch vessels, while 4 (16%) patients had stents implanted in the iliac arteries. When branch vessel cannulation failed, fenestrations were made in the intimal flap to improve perfusion of the involved branch (n=5). In the nonischemic group, 3 arteries were stented owing to atherosclerotic stenosis. Technical success was achieved in 62 (97%) of 64 patients; despite stenting, 2 patients had low renal artery perfusion on final angiography. There were no statistically significant differences in early or late outcomes between the nonischemic vs ischemic cATBAD patients. Six (9%) patients died within 30 days: 2 (5%) in the nonischemic group vs 4 (16%) in the ischemic group. Major complications (1 stroke, 2 cases of paraplegia, 1 retrograde type A dissection, and 1 case of bowel ischemia) occurred only in the nonischemic group. The mean follow-up was 28 months. Late endoleaks were observed in 3 (8%) nonischemic patients and 1 (4%) ischemic patient. Reinterventions were required in 7 (18%) nonischemic patients and 4 (16%) ischemic patients. Conclusion: TEVAR is an effective and safe method of treating cATBAD. Early intervention in ischemic cATBAD may have played a significant role in the lack of significant difference between ischemic and nonischemic cATBAD outcomes. Direct visceral reperfusion through branch vessel stenting during TEVAR may be crucial in achieving good outcomes in ischemic cATBAD.

Complications after Endovascular Repair of Type B Aortic Dissection

2002 ◽  
Vol 9 (6) ◽  
pp. 822-828 ◽  
Author(s):  
Reinhard S. Pamler ◽  
Thomas Kotsis ◽  
Johannes Görich ◽  
Xaver Kapfer ◽  
Karl-Heinz Orend ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Stent Grafting ◽  
Stent Graft Implantation ◽  
Graft Implantation

Purpose: To outline the complications encountered after endoluminal treatment in patients with type B aortic dissection. Methods: Between 1999 and 2001, 14 patients (12 men; mean age 60.3 years, range 39–79) with isolated type B aortic dissection (13 chronic, 1 acute) underwent aortic stent-grafting. Three patients with chronic dissection presented an acute clinical picture and were managed emergently. The left subclavian artery was intentionally covered by the prosthesis in 9 patients. Follow-up studies were performed at 6-month intervals. Results: Stent-graft implantation was technically successful in all patients, but incomplete sealing (endoleak) of the entry site required additional proximal stent-graft implantation in 4. The left subclavian artery remained patent in 5 patients. Secondary conversion was required in 3 patients: 2 for acute type A dissection resulting from injury to the aortic arch by Talent endografts and a sustained hemorrhage (left hemothorax). In another patient, a secondary intramural hematoma subsided spontaneously. Anterior spinal artery syndrome in 1 patient persisted at 1 month. No bypass was necessary for the 9 patients with the covered left subclavian arteries. Mean follow-up was 14 months (range 1–23). Conclusions: Stent-grafting is feasible in patients with type B aortic dissection, although it is associated with a considerable rate of complications. Frank reporting of these sequelae for a variety of stent-grafts is of paramount importance to clarifying the limitations of the method.

Type B Aortic Dissection Complicated by Intimo-Intimal Intussusception and Extensive Intimal Denuding: Case Report with Long-term Follow-up

2020 ◽  
Vol 69 ◽  
pp. 451.e5-451.e10
Author(s):  
Mary Lin ◽  
Alison O. Flentje ◽  
Charles Drucker ◽  
Siamak Dahi ◽  
Aakash Shah ◽  
...  
Keyword(s):  
Case Report ◽  
Aortic Dissection ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Long Term Follow Up ◽  
Intimal Intussusception

Computed tomography findings and in-hospital mortality in patients with rupture of type B aortic dissection

2019 ◽  
Vol 61 (1) ◽  
pp. 136-144
Author(s):  
Tetsuhiro Otsuka ◽  
Eijun Sueyoshi ◽  
Yutaro Tasaki ◽  
Masataka Uetani
Keyword(s):  
Computed Tomography ◽  
Aortic Dissection ◽  
Hospital Mortality ◽  
Female Gender ◽  
Pleural Space ◽  
Hazard Ratio ◽  
Maximum Diameter ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Ct Findings

Background The relationships between the computed tomography (CT) findings and outcomes of patients with ruptured type B aortic dissection have not been clarified. Purpose To evaluate the initial CT findings of patients with ruptured type B aortic dissection and investigate the relationships between the initial CT findings and in-hospital mortality. Material and Methods This study was approved by the institutional review board. Thirty-three patients were diagnosed with ruptured Stanford type B aortic dissection at our hospital between 2007 and 2016 (21 men, 12 women; mean age = 76.1±10.7 years). We retrospectively evaluated the initial CT findings of ruptured type B aortic dissection and the relationships between clinical factors and in-hospital mortality using logistic regression analysis. Results Type B aortic dissections ruptured in the acute and chronic phases in 23 and 10 patients, respectively. The initial CT images showed various findings, including an open false lumen (58%), arch involvement (88%), hematomas in the pleural space (55%), hematomas in the pericardial space (18%), and the extravasation of vascular contrast material (12%). The mean maximum diameter of the affected aorta was 49.5 ± 16.1 mm. Among the 33 patients, 14 died at hospital. Female gender (hazard ratio = 10.284; 95% confidence interval [CI] = 1.61–65.54; P = 0.0136) and the presence of a hematoma in the pleural space (hazard ratio = 6.803; 95% CI = 1.07–43.24; P = 0.0421) were found to be predictors of in-hospital mortality. Conclusion Female gender and the presence of a hematoma in the pleural space are significant predictors of in-hospital mortality in patients with ruptured type B aortic dissection.

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