Anastomotic leak after surgical repair of type A aortic dissection – prevalence and consequences in midterm follow-up

Abstract

a These authors contributed equally to this paper Summary: Background: This study reports the mid-term prevalence and therapeutic consequences of anastomotic leaks after surgery for Stanford type A aortic dissections. Patients and methods: From July 2007 to July 2013, 93 patients survived surgery for acute type A dissections at our center and underwent a standardized follow-up. The pre-, peri-, and postoperative as well as the midterm results were collected prospectively. Follow-up computed tomography (CT) imaging was performed 7 days, 3, and 12 months after surgery, and yearly thereafter, to assess the presence or progression of anastomotic leaks at the aorto-prosthesis anastomotic sites. Results: The mean follow-up was 4 years (1534 ± 724 days). Follow-up CT revealed anastomotic leaks in 4 patients (4.3 %). All leaks developed during midterm follow-up and half of them did not increase with time. Two patients required redo surgery for an increase in periaortic extravasation and compression of neighboring structures. Further analysis was not able to reveal independent risk factors for development or deterioration of leaks. Conclusions: Anastomotic leaks after surgery for Stanford Type A aortic dissection can develop in midterm follow-up, even after initially excellent results. Meticulous follow-up is mandatory to detect possible deterioration and a need for redo surgery.Keywords: Aortic dissection, Stanford type A aortic dissection, cardiac surgery, anastomotic leak, CT angiography type A aortic dissection patients, incidence of anasto motic leaks, development of pseudoaneurysms, and their clinical signifi cance remain largely unknown. This study monitored the prevalence of such a pathology during the midterm follow-up after surgical repair of type A aortic dissection and attempted to explore the therapeutic options and management strategy for this complication.

Transcatheter Closure of Anastomotic Leakage of Aortic Root after Aortic Surgery for Type A Dissection: Two Case Reports

“…If Cabrol shunting is present in the echocardiogram and an anastomotic leakage is not easily detected, the sonographer should carefully look for the leakage to avoid misdiagnosis. Transcatheter closure is the preferred procedure for high-risk patients who cannot tolerate secondary thoracotomy [2,5]. The selection of the occluder also differs according to the leakage location, shape, and size.…”

Image Predictors of Treatment Outcome after Thoracic Aortic Dissection Repair

“…Refilling of the false lumen after repair of a type A aortic dissection is usually secondary to a persistent intimal tear at the aortic arch, a leak of the distal graft anastomosis, or refilling from the false lumen of a dissected aortic arch vessel. A leak from a distal graft anastomosis that was placed to treat type A dissection is seen in 5%-20% of cases (59,60) (Figs 19-22). If the leak is minimal, follow-up with CT is the best conservative approach; otherwise, TEVAR or surgery can help cover and close the leak.…”

Techniques and outcomes of percutaneous aortic anastomosis leak closure after frozen elephant trunk procedure for aortic dissection

“…The covering of proximal tears in the descending aorta through an FET stent-graft induces false lumen thrombosis and promotes satisfactory aortic remodeling ( 5 ). However, proximal aortic anastomosis leak (AAL), which is defined as a shunt originating from the aortic lumen through the suture dehiscence between the FET stent-graft and the native aorta, occurs in 4.3% patients after the FET procedure ( 6 , 7 ). This complication causes false lumen patency and a poor prognosis of aortic dissection, which should be corrected early.…”