Retrograde Aortic Dissection After Thoracic Endovascular Aortic Repair

Canaud, Ludovic; Ozdemir, Baris Ata; Patterson, Benjamin O.; Holt, Peter; Loftus, Ian; Thompson, Matt

doi:10.1097/sla.0000000000000585

Cited by 206 publications

(138 citation statements)

References 60 publications

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“…The incidence of RTAD after TEVAR for acute type B aortic dissection was 8.4% and 3% for chronic dissection [31] ; however, the overall mortality of this catastrophic complication could be as high as 33.6% to 57%. [31,32] The occurrence proved to be related with incomplete design of stent-graft system, rough handling, and presence of vascular wall lesions. [33] Indeed, the extent of graft oversizing was associated with an increased risk of RTAD.…”

Section: Discussionmentioning

confidence: 99%

“…Increased graft oversizing (>9%) appeared to translate to an increased relative risk of RTAD by 14% for each percent oversize, so many clinicians consider a 10% oversize was appropriate. [31,32,34] Inappropriate endograft oversizing should be avoided, a close surveillance program is recommended and immediately surgical procedure should be performed in case of retrograde type A aortic dissection. [35] …”

Section: Discussionmentioning

confidence: 99%

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Early and midterm outcomes of thoracic endovascular aortic repair (TEVAR) for acute and chronic complicated type B aortic dissection

Zhang

Du²,

Guo³

et al. 2017

Medicine

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Thoracic endovascular aortic repair (TEVAR) in the current era has been chosen as a dominant and minimally invasive treatment for complicated aorta dissection. This study aimed to assess safety and feasibility of TEVAR in acute and chronic type B aortic dissection.Between January 2011 and December 2013, 85 patients with complicated type B aortic dissection undergoing TEVAR were divided into acute aortic dissection (AAD) (n = 60) group and chronic aortic dissection (CAD) group (n = 25). Computed tomography was used to evaluate postoperative changes in maximal aortic diameter and true and false lumen diameters at 3 levels during a mean follow-up period of 26.4 ± 15.6 months.The technical success rate was 100%. In-hospital and 30-day rates of death were 3.3% in acute group and 0 in chronic group. Postdischarge rates of type I leak, type II leak, and retrograde type A dissection were 6.7%, 5.2%, and 3.4% (acute) and 0%, 4.0%, and 4.0% (chronic), respectively. The maximal aorta diameter remained stable in all the 3 levels in both acute and chronic group. The cumulative freedom from all-cause mortality at 3 years was similar in acute and chronic groups (89.5% vs 95.5%, P = .308). The cumulative freedom from aortic-related mortality was also not significantly different in the acute and chronic groups (92.8% vs 95.2%, P = .531). In the thoracic aorta, TEVAR treatment resulted in a significant increase in true lumen (TL) diameter and decrease in false lumen (FL). However, in the abdominal aorta, TEVAR did not lead to significant change in TL and FL diameters. The rates of complete thrombosis thoracic false lumens were better than that in the abdominal false lumen.TEVAR was a safe and effect therapy for complicated acute and chronic type B dissection with low early and mid-term mortality and morbidity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Early and midterm outcomes of thoracic endovascular aortic repair (TEVAR) for acute and chronic complicated type B aortic dissection

Zhang

Du²,

Guo³

et al. 2017

Medicine

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“…[73][74][75][76] In general, oversizing by no more than 0-10% is recommended for patients with TBAD. 74,77 Mis-sizing of the stent-graft can be avoided by keeping in mind the dynamic behavior of the aorta. [78][79][80] Adequate device size should be based on the diameter of the aorta proximal to the dissected segment.…”

Section: Endovascular Procedures Tevar (Thoracic Endovascular Aortic mentioning

confidence: 99%

Update in the management of type B aortic dissection

et al. 2016

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Stanford type B aortic dissection (TBAD) is a life-threatening aortic disease. The initial management goal is to prevent aortic rupture, propagation of the dissection, and symptoms by reducing the heart rate and blood pressure. Uncomplicated TBAD patients require prompt medical management to prevent aortic dilatation or rupture during subsequent follow-up. Complicated TBAD patients require immediate invasive management to prevent death or injury caused by rupture or malperfusion. Recent developments in diagnosis and management have reduced mortality related to TBAD considerably. In particular, the introduction of thoracic stent-grafts has shifted the management from surgical to endovascular repair, contributing to a fourfold increase in early survival in complicated TBAD. Furthermore, endovascular repair is now considered in some uncomplicated TBAD patients in addition to optimal medical therapy. For more challenging aortic dissection patients with involvement of the aortic arch, hybrid approaches, combining open and endovascular repair, have had promising results. Regardless of the chosen management strategy, strict antihypertensive control should be administered to all TBAD patients in addition to close imaging surveillance. Future developments in stent-graft design, medical therapy, surgical and hybrid techniques, imaging, and genetic screening may improve the outcomes of TBAD patients even further. We present a comprehensive review of the recommended management strategy based on current evidence in the literature.

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“…Twenty nine percent of RADs occur after the 30-day [4][5] The fragility of the ascending aortic wall and stent graftrelated factors including an oversized stent, aggressive balloon, and the use of proximal bare stent grafts all may contribute to the incidence of RAD. [4][5][6] Iatrogenic intimal injury can also result in RAD and is usually triggered by the partial clamp placement or inadequate intimato-intima approximation during proximal anastomosis of the debranched graft vessels. [7][8][9] Iatrogenic ascending aortic dissection occurs more frequently in the presence of other predisposing factors such as atherosclerosis of the aorta, thin dilated aortic walls, cystic medial necrosis, connective tissue disease, and dissection and aneurysm in the adjacent segment of aorta.…”

Section: Discussionmentioning

confidence: 99%