Aortic remodeling, volumetric analysis, and clinical outcomes of endoluminal exclusion of acute complicated type B thoracic aortic dissections

Kim, Karen M.; Donayre, Carlos E.; Reynolds, Tyler S.; Kopchok, George E.; Walot, Iwin; Chauvapun, Joe P.; White, Rodney A.

doi:10.1016/j.jvs.2010.11.134

Cited by 61 publications

(40 citation statements)

References 38 publications

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“…In the abdominal aorta, the change of hemodynamics was far behind that found in the proximal descending aorta, which suggested that the capacity of aortic remodeling was less in distal aorta. This result was consistent with those reported by Kim et al [20]; they substantiated the coverage of proximal intimal tear led to lower pressure in residual false lumen, which reduced the risk of aneurysmal expansion and rupture. Nevertheless, our finding was contrast to the results substantiated by Schoder et al [21], which has proven that the true and false lumen diameter in abdominal aorta level increased in 61% and 56% patients one year after surgery, respectively.…”

Section: Discussionsupporting

confidence: 93%

Aortic Remodeling Following Sun’s Procedure for Acute Type A Aortic Dissection

Luo

Tang

et al. 2017

Med Sci Monit

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BackgroundSun’s procedure is a surgical technique widely used in type A aortic dissection. The purpose of this study was to analyze clinical outcomes and morphologic changes in true and false lumen by computed tomography (CT) angiography after Sun’s procedure.Material/MethodsWe retrospectively reviewed 51 patients who underwent Sun’s procedure for acute Stanford type A aortic dissection extending down to iliac bifurcation between January 2013 and December 2014. The images of preoperative, one-month, three-month, and six-month follow-up were analyzed by CT angiography to measure the area and diameter of true and false lumen.ResultsFour patients died before surgical intervention and postoperative deaths occurred in five patients (in-hospital mortality rate 10.6%). Only 42 patients (36 male, 6 female; mean age, 45.9±9.8 years; range, 24–65 years) with acute type A aortic dissection were involved in our study. Thirty-five patients (83.3%) suffered from chest or abdominal pain and only one patient (2.4%) was asymptomatic. Thirty-seven patients (88.1%) had hypertension as the most common comorbidity. In the ascending aorta, false lumen was eliminated and the change of true lumen was not significant (p>0.05). In the descending aorta, complete and partial thrombosis of false lumen were observed in eight patients (19.0%) and 33 patients (78.6%) by one-month follow-up CT scan, respectively. After the six-month follow-up, the rate of complete thrombosis increased to 36.1% and partial thrombosis decreased to 61.9%. The area and maximal diameter of true lumen were increased significantly (p<0.05), whereas significant decreases were found in the area and maximal diameter of false lumen (p<0.05). In the abdominal aorta, thrombosis was found in 52.4% patients at one-month follow-up CT. Furthermore, there were no significant changes in both true and false lumen within three months (p>0.05). Nevertheless, the false luminal area and maximal diameter decreased significantly (p<0.05) after six months, while these changes of true lumen were not significant (p>0.05).ConclusionsAfter Sun’s procedure, aortic remodeling was a continuous process and occurred in a predictable model, and the extent of aortic remodeling varied at different levels. Remodeling in descending thoracic aorta was earlier than it was in abdominal aorta.

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Section: Discussionsupporting

confidence: 93%

Aortic Remodeling Following Sun’s Procedure for Acute Type A Aortic Dissection

Luo

Tang

et al. 2017

Med Sci Monit

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“…Aortic dimensions and morphological evidence of remodeling was assessed from the latest tomography imaging; aortic remodeling 21 required sealed entry, thrombosed thoracic false lumen with shrinkage along the stent graft, and absence of total diameter progression at levels A and B representing dissected proximal and distal thoracic aortic segments (Figure 1). …”

Section: Clinical Outcomes and End Pointsmentioning

confidence: 99%

“…21,34 With completed 5-year surveillance in all survivors, any discordance Nonetheless, with 3 conversions to open surgery in both groups within 2 years, and 2 cases of spinal injury, TEVAR is not always safe 35,36 ; however, procedural risk may be lowered by referral to high-volume centers, preemptive carotido-subclavian bypass and dissection-specific endoprosthetic technology. Moreover, elective TEVAR within 90 days of dissection benefits from ongoing aortic plasticity with better remodeling.…”

Section: Downloaded Frommentioning

confidence: 99%

Endovascular Repair of Type B Aortic Dissection

Nienaber

Kische

Rousseau

et al. 2013

Circ: Cardiovascular Interventions

894

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Background-Thoracic endovascular aortic repair (TEVAR) represents a therapeutic concept for type B aortic dissection.Long-term outcomes and morphology after TEVAR for uncomplicated dissection are unknown. Methods and Results-A total of 140 patients with stable type B aortic dissection previously randomized to optimal medical treatment and TEVAR (n=72) versus optimal medical treatment alone (n=68) were analyzed retrospectively for aortaspecific, all-cause outcomes, and disease progression using landmark statistical analysis of years 2 to 5 after index procedure. Cox regression was used to compare outcomes between groups; all analyses are based on intention to treat. From the University of Rostock, Heart Center and Institute for Biostatistics, Rostock, Germany (C.A.N., S.K., T.C.R., G.K., A.G., T.K., H.I.); CCB Heart Center Frankfurt, Frankfurt, Germany (H.E.); University Heart Center Leipzig, Leipzig, Germany (D.S.); German Heart Institute Berlin, Berlin, Germany (B.Z.); the Centre Hospitalière Universitaire, Hôpital de Rangueil, Toulouse, France (H.R.); the Universitá St. Orsola Malpighi, Bologna, Italy (R.F.); the Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland (M.C.); and Bordeaux Heart University Hospital, Bordeaux, France (L.L.).All members of the Investigation of Stent grafts in Aortic Dissection with extended length of follow-up (INSTEAD-XL) study group are listed in the Appendix in the online-only Data Supplement.The online-only Data Supplement is available at http://circinterventions.ahajournals.org/lookup/suppl

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“…Remodeling occurs shortly after TEVAR and remains predictable up to 5 years. 4) Kim, et al 4) also reported that a lack of increase in the true lumen volume was associated with endoleaks or distal reperfusion, indicating the importance of remodeling after treatment. 4) …”

Section: Discussionmentioning

confidence: 98%

Successful Remodeling and Endovascular Repair of a Ruptured Type B Chronic Aortic Dissection 12 Years after Primary Surgery

Hori

Yasuda

Nishi

et al. 2014

ATCS

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A 70-year-old woman with a medical history of descending aorta replacement for chronic type B aortic dissection 12 years prior was admitted to our hospital with sudden back pain and hemoptysis. The patient was diagnosed with ruptured residual dissected thoracic aortic aneurysm and underwent emergent endovascular treatment. Two TAG thoracic endoprosthesis of different sizes were used to accommodate the discrepancy in size of the true lumen, resulting in a successful closure of the entry tear and hemostasis, without any damage to the intima. Computed tomography performed 3 months after surgery revealed successful remodeling of the remaining aorta. Thoracic endovascular aortic replacement may be considered as an option in the treatment of chronic dissected aortic aneurysm, achieving not only entry closure but possibly remodeling, as well.

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Aortic remodeling, volumetric analysis, and clinical outcomes of endoluminal exclusion of acute complicated type B thoracic aortic dissections

Cited by 61 publications

References 38 publications

Aortic Remodeling Following Sun’s Procedure for Acute Type A Aortic Dissection

Aortic Remodeling Following Sun’s Procedure for Acute Type A Aortic Dissection

Endovascular Repair of Type B Aortic Dissection

Successful Remodeling and Endovascular Repair of a Ruptured Type B Chronic Aortic Dissection 12 Years after Primary Surgery

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