Outflow Through Aortic Side Branches Drives False Lumen Patency in Type B Aortic Dissection

Objective: Thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD) aims to induce false lumen (FL) thrombosis by sealing intimal tears between the true (TL) and the FL, and blocking the inflow into the FL. Incomplete thrombosis of the FL is correlated with poor clinical outcome. We hypothesize that the number of major and minor branches arising from the FL affects FL patency and may negatively influence TEVAR induced FL thrombosis.Methods: Computed tomography (CT)-scans from 89 patients diagnosed with TBAD [best medical treatment (BMT) n = 52, TEVAR n = 37] from two high-volume vascular surgery centers were analyzed retrospectively. Analysis included evaluation of the FL patency status, the number, location and size of intimal tears, and the presence of minor and major side branches originating from the FL. Multiple regression analysis was conducted to evaluate obtained parameters as predictors for FL thrombosis status.Results: In univariate analysis, the strongest correlation for FL patency was found for the number of major (R = 0.79) and minor (R = 0.86) side branches originating from the FL. When applying a multiple linear regression model, the number of major (normalized beta 0.37; P < 0.001) and minor (normalized beta 0.41; P < 0.01) side branches arising from the FL were valid predictors for the axial length of the patent and non-patent FL, and additionally determined the length of the patent FL at 12-month follow-up in patients that underwent TEVAR.Conclusions: Our data suggest that the number of minor side branches that originate from the FL in TBAD is an important determinant of FL patency, to a greater degree than previously assumed.

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Management of a Compromised Frozen Elephant Trunk Due to Acute Type B Aortic Dissection

Vascular and Endovascular Surgery ◽

10.1177/1538574420949313 ◽

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.

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Frequency of abdominal aortic expansion after thoracic endovascular repair of type B aortic dissection

Vascular ◽

10.1177/1708538115627249 ◽

2016 ◽

Vol 24 (6) ◽

pp. 567-579 ◽

Cited By ~ 8

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.

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Endovascular Repair of Acute Type B Aortic Dissection: Long-Term Follow-Up of True and False Lumen Diameter Changes

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2006.10.064 ◽

2007 ◽

Vol 83 (3) ◽

pp. 1059-1066 ◽

Cited By ~ 117

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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Long-term Follow-up of Acute type B Aortic Dissection: Ulcer-like Projections in Thrombosed False Lumen Play a Role in Late Aortic Events

Journal of Vascular Surgery ◽

10.1016/j.jvs.2012.03.032 ◽

2012 ◽

Vol 55 (5) ◽

pp. 1541-1542

Author(s):

S. Miyahara ◽

N. Mukohara ◽

M. Fukuzumi

Keyword(s):

Aortic Dissection ◽

False Lumen ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection ◽

Long Term Follow Up

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Long-term follow-up of acute type B aortic dissection: Ulcer-like projections in thrombosed false lumen play a role in late aortic events

Yearbook of Vascular Surgery ◽

10.1016/j.yvas.2012.04.053 ◽

2012 ◽

Vol 2012 ◽

pp. 149-152

Author(s):

G.L. Moneta

Keyword(s):

Aortic Dissection ◽

False Lumen ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection ◽

Long Term Follow Up

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Abstract 6192: Endovascular Stent-Graft Repair of Type B Aortic Dissection: Intermediate to Long-Term Results

Circulation ◽

10.1161/circ.118.suppl_18.s_1078-b ◽

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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Outcome after acute und subacute TEVAR in uncomplicated type B aortic dissection

British Journal of Surgery ◽

10.1093/bjs/znab202.069 ◽

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

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

Journal of Integrative Cardiology Open Access ◽

10.31487/j.jicoa.2020.03.03 ◽

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.

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