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 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.

Spinal Cord Ischemia in the Setting of Acute Type B Aortic Dissection: Successful Rescue with Thoracic Endovascular Aortic Repair

2021 ◽  
pp. 153857442110451
Author(s):  
Masaki Kano ◽  
Toru Iwahashi ◽  
Toshiya Nishibe ◽  
Kentaro Kamiya ◽  
Hitoshi Ogino
Keyword(s):  
Spinal Cord ◽  
Aortic Dissection ◽  
Medical Management ◽  
Spinal Cord Ischemia ◽  
False Lumen ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection

We report 2 cases of successful thoracic endovascular aortic repair (TEVAR) for acute type B aortic dissection (ABAD) complicated with spinal cord ischemia (SCI). Case 1. A 70-year-old gentleman found with an uncomplicated ABAD with false lumen occluded, developed SCI shortly after admission during the initial medical management. Cerebrospinal fluid drainage (CSFD) was initiated followed by emergent TEVAR. SCI improved, and the patient was discharged. Case 2. A 52-year-old gentleman developed uncomplicated ABAD with patent false lumen. 5 hours after admission, he developed SCI during the initial medical management. Emergent TEVAR was performed followed by CSFD, and the SCI improved before discharge. These cases prompted us to address prompt TEVAR for primary entry closure and true lumen dilatation with postoperative hypertensive management to relieve the dynamic obstruction of the segmental arteries responsible for the compromised spinal cord circulation in complicated ABAD.

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.

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.

Dissection length-to-descending thoraco-abdominal aorta length ratio predicts abdominal aortic enlargement after thoracic endovascular aortic repair for type B aortic dissection involving the abdominal aorta

2020 ◽  
Vol 31 (5) ◽  
pp. 680-687
Author(s):  
Xinhao Wang ◽  
Yangyang Ge ◽  
Xiaohu Ge ◽  
Jianhang Miao ◽  
Weidong Fan ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Abdominal Aorta ◽  
Cumulative Incidence ◽  
Inflection Point ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Nonlinear Relationship ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Abdominal Aortic

Abstract OBJECTIVES This study was performed to assess the association between the dissection length-to-descending thoraco-abdominal aorta length ratio (LLR) and abdominal aortic enlargement (AAE) (≥20% increase in total abdominal aortic volume) after thoracic endovascular aortic repair (TEVAR) in patients with type B aortic dissection. METHODS We retrospectively analysed data from 184 consecutive patients with type B aortic dissection who underwent TEVAR from January 2011 to December 2016 at 4 hospitals as part of the Registry Of type B aortic dissection with Utility of STent graft study. Preoperative and postoperative computed tomography angiography images were reviewed to assess the LLR and AAE. Patients were stratified into tertiles according to the pre-TEVAR LLR: 0.7 to <1.0 (n = 61), 1.0 to <1.2 (n = 61) and 1.2 to <1.6 (n = 62). The thoracic and abdominal aorta were divided by the celiac trunk. The cumulative incidence of AAE was estimated using the Kaplan–Meier method. A multivariable Cox proportional hazards model was used to assess the independent association between the preoperative LLR and the post-TEVAR risk of AAE. The nonlinear relationship between the LLR and the risk of post-TEVAR AAE was fitted by the restricted cubic smoothing spline, and the inflection point on the fitting curve was determined using a piecewise linear regression model. RESULTS Baseline demographics, clinical features, preoperative anatomic characteristics and implanted devices were similarly distributed among the pre-TEVAR LLR tertile groups. At 24 months post-TEVAR, the estimated cumulative incidence of AAE significantly differed (P < 0.01) by LLR tertile group: 0.10 [95% confidence interval (CI) 0.00–0.21], 0.65 (95% CI 0.45–0.78) and 0.67 (95% CI 0.40–0.82), respectively. The pre-TEVAR LLR was an independent predictor of post-TEVAR AAE [hazard ratio (per unit increase) 1.03, 95% CI 1.01–1.04] following a nonlinear relationship with an inflection point at LLR = 1.0. CONCLUSIONS The risk of post-TEVAR AAE is highest when the length of the dissection is greater than or equal to the length of the descending aorta (LLR ≥ 1.0).

Using Machine Learning to Predict Five-Year Reintervention Risk in Type B Aortic Dissection Patients After Thoracic Endovascular Aortic Repair

2021 ◽  
Vol 11 (6) ◽  
pp. 1560-1567
Author(s):  
Weiyuan Lin ◽  
Lifeng Que ◽  
Guisen Lin ◽  
Rui Chen ◽  
Qiyang Lu ◽  
...  
Keyword(s):  
Machine Learning ◽  
Risk Factors ◽  
High Risk ◽  
Aortic Dissection ◽  
Thoracic Endovascular Aortic Repair ◽  
Type B ◽  
Imaging Data ◽  
Type B Aortic Dissection ◽  
Medical Guidelines

Purpose: Type B aortic dissection (TBAD) is a high-risk disease, commonly treated with thoracic endovascular aortic repair (TEVAR). However, for the long-term follow-up, it is associated with a high 5-year reintervention rate for patients after TEVAR. There is no accurate definition of prognostic risk factors for TBAD in medical guidelines, and there is no scientific judgment standard for patients’ quality of life or survival outcome in the next five years in clinical practice. A large amount of medical data features makes prognostic analysis difficult. However, machine learning (ML) permits lots of objective data features to be considered for clinical risk stratification and patient management. We aimed to predict the 5-year prognosis in TBAD after TEVAR by Ml, based on baseline, stent characteristics and computed tomography angiography (CTA) imaging data, and provided a certain degree of scientific basis for prognostic risk score and stratification in medical guidelines. Materials and Methods: Dataset we recorded was obtained from 172 TBAD patients undergoing TEVAR. Totally 40 features were recorded, including 14 baseline, 5 stent characteristics and 21 CTA imaging data. Information gain (IG) was used to select features highly associated with adverse outcome. Then, the Gradient Boost classifier was trained using grid search and stratified 5-fold cross-validation, and Its predictive performance was evaluated by the area under the curve (AUC) in the receiver operating characteristic (ROC). Results: Totally 60 patients underwent reintervention during follow-up. Combing 24 features selected by IG, ML model predicted prognosis well in TBAD after TEVAR, with an AUC of 0.816 and a 95% confidence interval of 0.797 to 0.837. Reintervention rate of prediction was slightly higher than the actual (48.2% vs. 34.8%). Conclusion: Machine learning, which combined with baseline, stent characteristics and CTA imaging data for personalized risk computations, effectively predicted reintervention risk in TBAD patients after TEVAR in 5-year follow-up. The model could be used to efficiently assist the clinical management of TBAD patients and prompt high-risk factors.

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
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