Aortic Remodeling After Endovascular Treatment of Complicated Type B Aortic Dissection Using a Composite Device Design: A Report from the STABLE Trial

Secondary Interventions Following Endovascular Repair of Aortic Dissections

“…Despite the ability of the endograft to cover the proximal entry tear leading to aortic remodeling, continued re-entry flow into the false lumen is quite common. Review of the current literature suggests that the initial stent graft only achieves both thoracic and abdominal false lumen obliteration in only 50% of patients [5]. Since the focus of our literature review was secondary interventions, this low rate of thrombosis is not surprising as it is skewed toward patients failing initial therapy in our review.…”

“…While retrograde aortic dissection was not as common in this subset of patients, it was proportionally, the complication that most frequently required secondary intervention. This complication is highly correlative to patients who have "involved" aorta at the proximal seal zone [5]. Intramural thrombus or gross dissection extending just proximal to the left subclavian artery is an example of anatomy predisposing to retrograde propagation in the setting of TEVAR.…”

“…Very little attention has been brought to the natural progression of this disease state after TEVAR and intervention that could alter the progression of aneurysmal degeneration after TEVAR. Primary entry tear coverage is a paramount first step to successfully exclude the false lumen [3,4].While stent grafts are a beneficial tool in the treatment of aortic dissections, it fails to achieve complete false lumen thrombosis in up to 50% of patients [5]. Several studies have utilized secondary interventions to promote false lumen thrombosis and positive aortic remodeling.…”