Endovascular repair of complicated chronic distal aortic dissections: Intermediate outcomes and complications

Kang, Woong Chol; Greenberg, Roy K.; Mastracci, Tara M.; Eagleton, Matthew J.; Hernandez, Adrián V.; Pujara, Akshat C.; Roselli, Eric E.

doi:10.1016/j.jtcvs.2011.03.008

Cited by 152 publications

(136 citation statements)

References 34 publications

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“…The early mortality rate for TAA and chronic type B aortic dissection reported in the present study was similar to that described in several large series [14][15][16] and considerably better than that reported in community analyses. 17 The difference in adverse outcomes between the elective treatment of TAA and chronic type B aortic dissection was related to a higher incidence of stroke in patients with aneurysms.…”

Section: Discussionsupporting

confidence: 91%

Aortic Pathology Determines Midterm Outcome After Endovascular Repair of the Thoracic Aorta

et al. 2013

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Given the spectrum of different pathologies that affect the descending thoracic aorta, it is important to define whether the outcome of TEVAR is pathology specific to refine procedural technique and endograft design. Careful analysis of long-term Background-Endovascular repair of the thoracic aorta has become an increasingly utilized therapy. Although the shortterm mortality advantage over open surgery is well documented, late mortality and the impact of presenting pathology on long-term outcomes remain poorly reported. Methods and Results-A database was built from 5 prospective studies and a single institutional series. Rates of perioperative adverse events were calculated, as were midterm death and reintervention rates. Multivariate analysis was performed with the use of logistic regression modeling. Kaplan-Meier survival curves were drawn for midterm outcomes. The database contained 1010 patients: 670 patients with thoracic aortic aneurysm, 195 with chronic type B aortic dissection, and 114 with acute type B aortic dissection. Lower elective mortality was observed in patients with chronic dissections (3%) compared with patients with aneurysms (5%). Multivariate analysis identified age, mode of admission, American Society of Anesthesiologists grade, and pathology as independent predictors of 30-day death (P < 0.05). In the midterm, the all-cause mortality rate was 8, 4.9, and 3.2 deaths per 100 patient-years for thoracic aortic aneurysm, acute type B aortic dissection, and chronic type B aortic dissection, respectively. The rates of aortic-related death were 0.6, 1.2, and 0.4 deaths per 100 patient-years for thoracic aortic aneurysm, acute type B aortic dissection, and chronic type B aortic dissection, respectively. Conclusions-This study indicated that the midterm outcomes of endovascular repair of the thoracic aorta are defined by presenting pathology, associated comorbidities, and mode of admission. Nonaortic mortality is high in the midterm for patients with thoracic aortic aneurysm, and managing modifiable risk factors appears vital. Endovascular repair of the thoracic aorta results in excellent midterm protection from aortic-related mortality, regardless of presenting pathology. (Circulation. 2013;127:24-32.)

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Section: Discussionsupporting

confidence: 91%

Aortic Pathology Determines Midterm Outcome After Endovascular Repair of the Thoracic Aorta

et al. 2013

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“…In treating chronic dissections, it has been shown that FL thrombosis occurs more often in patients with limited dissection and that FL thrombosis occurs more effectively in the stented part of the DTA. 191 These findings suggest that the extent of coverage of the DTA is directly related to the extent of FL thrombosis. Although SCI rates after TEVAR for chronic dissection are lower than those after TEVAR for thoracic aneurysms, increased aortic coverage may increase the risk of SCI.…”

Section: Recommenda On 37mentioning

confidence: 84%

“…In addition, in ATBAD patients treated with TEVAR, distal perfusion of the FL is often observed, and its role remains poorly understood. 191 Therefore, routine surveillance should consist of physical examination, blood pressure control, and echocardiography, and mainly be done with MRA or CTA, based on patient characteristics (see also Table 3). …”

Section: Surveillancementioning

confidence: 99%

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Riambau¹,

Böckler²,

Brunkwall³

et al. 2017

European Journal of Vascular and Endovascular Surgery

872

259

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“…As such, the complete false lumen thrombosis was observed around the surgical-stent in 94.5% of patients and in 71.9% of patients at the diaphragmatic level, reported by Sun and colleagues in their experience of treatment for acute type A dissection 11) and the ability to halt or reverse aortic growth in the stented segment in 85% of patients is evident that TEVAR can protect the aortic wall from adverse morphologic changes in chronic distal dissection patients, reported by Kang and colleagues. 12) Although TEVAR has contributed significantly to the remodeling of aortic dissection, there remains a concern with regard to the stiff stent-graft which may injure the fragile aortic septum. Stent-graft induced new entry (SINE) is defined as a new tear caused by the stent-graft at proximal or distal ends.…”

Section: Discussionmentioning

confidence: 99%

Initial Experience of Modified Four-Branched Graft Technique and Antegrade TEVAR in Acute Type A Aortic Dissection

Chou

Lo²,

Chua³

et al. 2015

ATCS

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IntroductionTotal aortic arch repair represents a high-risk operation and may compromise the surgical decision due to the increased mortality and cerebral complications. The arch first technique with retrograde cerebral perfusion or selective antegrade cerebral perfusion was introduced to extend the safety period from cerebral ischemia during deep hypothermic circulatory arrest. However, profound hypothermia prolonged the myocardial ischemic time and cardiopulmonary bypass (CPB) time, and induced coagulopathy which resulted in deteriorated myocardial function, end-organs dysfunction and excessive postoperative bleeding, 1) and the complex manipulation of antegrade cerebral perfusion may release debris from endo-clamping or snaring of arch vessels and the clustered tubes interrupted the operative field. Our modified four-branched graft technique for arch surgery had been reported in 2012, with advantages to evade selective antegrade cerebral perfusion and deep hypothermia.

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Endovascular repair of complicated chronic distal aortic dissections: Intermediate outcomes and complications

Cited by 152 publications

References 34 publications

Aortic Pathology Determines Midterm Outcome After Endovascular Repair of the Thoracic Aorta

Aortic Pathology Determines Midterm Outcome After Endovascular Repair of the Thoracic Aorta

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Initial Experience of Modified Four-Branched Graft Technique and Antegrade TEVAR in Acute Type A Aortic Dissection

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