Stent-Graft Treatment of Type B Aortic Dissection Involving the Right Aortic Arch

A 71-year-old man visited our hospital with the chief complaint of back pain and was diagnosed with acute aortic dissection (Debakey type III, Stanford type B). He was found to have a variant branching pattern in which the right subclavian artery was the fourth branch of the aorta. We performed conservative management for uncomplicated Stanford type B aortic dissection, and the patient was discharged. An ulcer-like projection (ULP) was discovered during outpatient follow-up. Complicated type B aortic dissection was suspected, and we performed thoracic endovascular aortic repair (TEVAR). The aim of operative treatment was ULP closure; thus we placed two stent grafts in the descending aorta from the distal portion of the right subclavian artery. The patient was released without complications on postoperative day 5. Deliberate sizing and examination of placement location were necessary when placing the stent graft, but operative techniques allowed the procedure to be safely completed.

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Association between aortic arch angulation and bird-beak configuration after thoracic aortic stent graft repair of type B aortic dissection

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa171 ◽

2020 ◽

Vol 31 (5) ◽

pp. 688-696

Author(s):

Long Cao ◽

Yangyang Ge ◽

Yuan He ◽

Xinhao Wang ◽

Dan Rong ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Stent Graft ◽

Multivariable Analysis ◽

Type B ◽

Type B Aortic Dissection ◽

Landing Zone ◽

Maximal Diameter ◽

Significant Difference ◽

Bird Beak

Abstract OBJECTIVES The goal of this study was to investigate factors favouring the bird-beak configuration after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection. METHODS We retrospectively analysed 76 patients with type B aortic dissection who underwent landing zone 1 and 2 TEVAR from December 2015 to January 2018. Preoperative aortic arch geometry (aortic arch length, maximal diameter and angulation), stent graft details and operative details were evaluated. A bird-beak configuration was defined as a ≥5-mm gap between the proximal end of the stent and the aortic wall of the lesser curvature. RESULTS Patients were stratified into those with (n = 46) and without (n = 30) a bird-beak configuration. The baseline demographics, dissection chronicity, clinical features and implanted devices were largely similar between the 2 groups. No significant difference was observed in the arch length or maximal arch diameter. However, the mean aortic arch angulation was greater in patients with than without a bird-beak configuration (61.4° vs 51.3°; P < 0.001). No influence of either the stent graft brand or the proximal stent graft type was observed. The multivariable analysis showed that the aortic arch angulation was an independent risk factor for a bird-beak configuration (odds ratio 1.15, 95% confidence interval 1.07–1.24; P < 0.001). A cut-off angle of 59.15° was predictive of a bird-beak configuration (sensitivity 59%; specificity 77%). CONCLUSIONS The preoperative aortic arch angulation was an independent predictor of a postoperative bird-beak configuration in patients with type B aortic dissection who underwent TEVAR that involved the aortic arch. An angle of >59.15° may imply a relatively hostile anatomy with a higher risk of a bird-beak configuration.

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Type B aortic dissection treated with a branched aortic arch stent graft and the STABILISE technique

Annals of Vascular Surgery ◽

10.1016/j.avsg.2021.03.028 ◽

2021 ◽

Author(s):

Pierre-Antoine Barral ◽

Alexis Jacquier ◽

Virgile Omnes ◽

Philippe Piquet ◽

Marine Gaudry

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Stent Graft ◽

Type B ◽

Type B Aortic Dissection

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Type B Aortic Dissection Treated with a Branched Aortic Arch Stent Graft and the STABILISE Technique Simple Abstract

Biomedical Journal of Scientific & Technical Research ◽

10.26717/bjstr.2020.31.005147 ◽

2020 ◽

Vol 31 (4) ◽

Author(s):

Barral Pierre Antoine

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Stent Graft ◽

Type B ◽

Type B Aortic Dissection

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Faculty Opinions recommendation of Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.9408957.10046056 ◽

2011 ◽

Author(s):

Lefeng Qu ◽

Jiaxuan Feng

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

Endovascular Repair ◽

Type B ◽

Type B Aortic Dissection ◽

Stanford Type B ◽

New Entry

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Complications after Endovascular Repair of Type B Aortic Dissection

Journal of Endovascular Therapy ◽

10.1177/152660280200900616 ◽

2002 ◽

Vol 9 (6) ◽

pp. 822-828 ◽

Cited By ~ 25

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.

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