Risk Factors of Early and Late Mortality After Thoracic Endovascular Aortic Repair for Complicated Stanford B Acute Aortic Dissection

Abstract

Type I procedural endoleak and cardiac tamponade were the significant predictors of early death in patients of complicated Stanford B AAD undergoing TEVAR. Rupture of false lumen, postoperative myocardial infarction, and acute renal failure were the independent risk factors for late death after TEVAR.

Biomechanical Changes After Thoracic Endovascular Aortic Repair in Type B Dissection

“…Endoleak type Ia and Ib have been reported as significant predictors of morbidity and mortality in TBAD patients; therefore, early intervention should be considered in these patients. 44,52,169 Stent-graft collapse and migration are rare complications for TEVAR following TBAD as the proximal neck does not usually dilate postoperatively. However, oversizing >20% should be avoided in TBAD patients because it is related to proximal neck dilatation and subsequent stent-graft migration.…”

“…Type Ia endoleak is caused by antegrade perfusion of the FL and is a significant predictor of death in TBAD. 44,52 The most common causes of type Ia endoleak are malapposition of the proximal segment of the stent-graft, mainly due to short proximal landing zone and severe angulation. 84,85 To prevent malapposition, oversizing in TBAD should not be greater than 20% to reduce the risk of proximal neck dilatation.…”

“…8,13 Despite the improved in-hospital outcomes, TBAD patients may present follow-up complications due to both disease progression, such as aortic dilatation and rupture, and stent-graft-related complications including migration, stent-graft collapse/fracture, retrograde aortic dissection (AD), extended dissection, and stent-graft-induced new entry tears. [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] Endoleaks may be associated with both clinical and biomechanical stent-graft conditions. The final success of TEVAR, as well as the development of aortic complications, is determined by the biomechanical behavior and interaction of the "rigid" implanted stent-grafts with the "elastic and fragile" thoracic aortic wall.…”

Emergency thoracic aortic stent grafting for acute complicated type B aortic dissection after a previous abdominal endovascular aneurysm repair

“…After treatment of TEVAR, approximately 25 % of the patients require reintervention due to endoleaks and increasing false lumens in size [7–9]. Furthermore, a ruptured false lumen was found to be an independent risk factor for the long-term survival [10]. Therefore, patients with a patent false lumen should be followed up carefully.…”

Explantation of a failed endovascular stent graft in a patient with a type B dissection

“…7,8 Although the mortality and morbidity rates of TEVAR are lower than those of open surgery, 1,4 the rate of open surgical conversion after failed TEVAR has been reported to range from 4% to 10%. 13 Coverage of the left subclavian artery, a small radius of curvature, and a greatest length of an unapposed proximal stent graft are risk factors for endoleak. Despite improvements in TEVAR techniques, the rate of failed TEVAR has been reported to be 11.3% and endovascular or surgical reintervention is required in 7.7% of cases.…”