Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Mid-Term Results of Thoracic Endovascular Aortic Repair for Complicated Acute Type B Aortic Dissection at a Single Center

  • Hong, Young Kwang (Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Seoul Hospital) ;
  • Chang, Won Ho (Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Seoul Hospital) ;
  • Goo, Dong Erk (Department of Radiology, Soonchunhyang University Seoul Hospital) ;
  • Oh, Hong Chul (Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Seoul Hospital) ;
  • Park, Young Woo (Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Seoul Hospital)
  • Received : 2020.12.14
  • Accepted : 2021.02.16
  • Published : 2021.06.05
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Abstract

Background: Complicated acute type B aortic dissection is a life-threatening condition with high morbidity and mortality. The aim of this study was to report a single-center experience with endovascular stent-graft repair of acute type B dissection of the thoracic aorta and to evaluate the mid-term outcomes. Methods: We reviewed 18 patients treated for complicated acute type B aortic dissection by thoracic endovascular aortic repair (TEVAR) from September 2011 to July 2017. The indications for surgery included rupture, impending rupture, limb ischemia, visceral malperfusion, and paraplegia. The median follow-up was 34.50 months (range, 12-80 months). Results: The median interval from aortic dissection to TEVAR was 5.50 days (range, 0-32 days). There was no in-hospital mortality. All cases of malperfusion improved except for 1 patient. The morbidities included endoleak in 2 patients (11.1%), stroke in 3 patients (16.7%), pneumonia in 2 patients (11.1%), transient ischemia of the left arm in 1 patient (5.6%), and temporary visceral ischemia in 1 patient (5.6%). Postoperative computed tomography angiography at 1 year showed complete thrombosis of the false lumen in 15 patients (83.3%). Conclusion: TEVAR of complicated type B aortic dissection with a stent-graft was effective, with a low morbidity and mortality rate.

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References

  1. Botsios S, Schuermann K, Maatz W, Keck N, Walterbusch G. Complicated acute type B dissections: a single-center experience with endovascular treatment. Thorac Cardiovasc Surg 2010;58:280-4. https://doi.org/10.1055/s-0030-1249942
  2. Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: part I: from etiology to diagnostic strategies. Circulation 2003;108:628-35. https://doi.org/10.1161/01.CIR.0000087009.16755.E4
  3. Lauterbach SR, Cambria RP, Brewster DC, et al. Contemporary management of aortic branch compromise resulting from acute aortic dissection. J Vasc Surg 2001;33:1185-92. https://doi.org/10.1067/mva.2001.115377
  4. Dake MD, Kato N, Mitchell RS, et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med 1999;340:1546-52. https://doi.org/10.1056/NEJM199905203402004
  5. Trimarchi S, Nienaber CA, Rampoldi V, et al. Role and results of surgery in acute type B aortic dissection: insights from the International Registry of Acute Aortic Dissection (IRAD). Circulation 2006; 114:I357-64.
  6. Khoynezhad A, Donayre CE, Omari BO, Kopchok GE, Walot I, White RA. Midterm results of endovascular treatment of complicated acute type B aortic dissection. J Thorac Cardiovasc Surg 2009;138: 625-31. https://doi.org/10.1016/j.jtcvs.2009.04.044
  7. Shu C, He H, Li QM, Li M, Jiang XH, Luo MY. Endovascular repair of complicated acute type-B aortic dissection with stentgraft: early and mid-term results. Eur J Vasc Endovasc Surg 2011;42:448-53. https://doi.org/10.1016/j.ejvs.2011.05.013
  8. Kim JT, Yoon YH, Lim HK, Yang KH, Baek WK, Kim KH. Thoracic endovascular stent graft repair for aortic aneurysm. Korean J Thorac Cardiovasc Surg 2011;44:148-53. https://doi.org/10.5090/kjtcs.2011.44.2.148
  9. Greenberg R, Khwaja J, Haulon S, Fulton G. Aortic dissections: new perspectives and treatment paradigms. Eur J Vasc Endovasc Surg 2003;26:579-86. https://doi.org/10.1016/S1078-5884(03)00415-5
  10. van Bogerijen GH, Williams DM, Patel HJ. TEVAR for complicated acute type B dissection with malperfusion. Ann Cardiothorac Surg 2014;3:423-7.
  11. Tolenaar JL, Jonker FH, Moll FL, et al. Influence of oversizing on outcome in thoracic endovascular aortic repair. J Endovasc Ther 2013;20:738-45. https://doi.org/10.1583/13-4388MR.1
  12. Liu L, Zhang S, Lu Q, Jing Z, Zhang S, Xu B. Impact of oversizing on the risk of retrograde dissection after TEVAR for acute and chronic type B dissection. J Endovasc Ther 2016;23:620-5. https://doi.org/10.1177/1526602816647939
  13. Han DK, Jokisch C, McKinsey J. Expanding the landing zone for TEVAR. Endovasc Today 2016;15:85-90.
  14. Dias NV, Sonesson B, Koul B, Malina M, Ivancev K. Complicated acute type B dissections: an 8-years experience of endovascular stent-graft repair in a single centre. Eur J Vasc Endovasc Surg 2006; 31:481-6. https://doi.org/10.1016/j.ejvs.2005.11.005
  15. Bradshaw RJ, Ahanchi SS, Powell O, et al. Left subclavian artery revascularization in zone 2 thoracic endovascular aortic repair is associated with lower stroke risk across all aortic diseases. J Vasc Surg 2017;65:1270-9. https://doi.org/10.1016/j.jvs.2016.10.111
  16. Gravereaux EC, Faries PL, Burks JA, et al. Risk of spinal cord ischemia after endograft repair of thoracic aortic aneurysms. J Vasc Surg 2001;34:997-1003. https://doi.org/10.1067/mva.2001.119890
  17. Leshnower BG, Duwayri YM, Chen EP, et al. Aortic remodeling after endovascular repair of complicated acute type B aortic dissection. Ann Thorac Surg 2017;103:1878-85. https://doi.org/10.1016/j.athoracsur.2016.09.057