Thoracic Endovascular Aortic Repair for Type A Intramural Hematoma and Retrograde Thrombosed Type A Aortic Dissection: A Single-Center Experience

Chen, Yen‐Yu; Yen, Hsu-Ting; Wu, Chia‐Chen; Huang, David Kwan-Ru

doi:10.1016/j.avsg.2019.11.016

Cited by 12 publications

(21 citation statements)

References 18 publications

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“…For the patients with retrograde type A IMH undergoing TEVAR, development of a new RAAD is one of the most serious complications that should not be ignored. In the current series the rate of RAAD was 4%, and another group also reported the occurrence of RAAD after TEVAR in retrograde type A IMH (24). There are several possible mechanisms.…”

Section: Discussionsupporting

confidence: 60%

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Endovascular repair for retrograde type A intramural hematoma with focal intimal disruption in descending aorta

Li¹,

Zhang²,

Peng³

et al. 2021

J Thorac Dis

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Background: This study aims to report the experience of a single center using thoracic endovascular aortic repair (TEVAR) to treat retrograde type A intramural hematoma (IMH) with focal intimal disruption (FID) in descending aorta. Methods: A total of 24 consecutive patients with retrograde type A IMH and complicated with FID in descending aorta underwent TEVAR in our center from 2015 to 2020. Their clinical data, imaging manifestation and follow-up results were retrospectively reviewed and analyzed. Results: The median age of patients was 57.9 years (range, 42-80) and 18 were men (75%). As the preoperative CT angiography showed, the 24 patients developed IMH complicated with different kinds of FIDs in descending aorta [5 had intramural blood pool (IBP), 15 had ulcer-like projection (ULP), 2 had penetrating atherosclerotic ulcer (PAU), and 5 had localized dissection]. Successful deployment of aortic stent graft was achieved in all patients. There was no endoleak, stent graft migration, spinal cord ischemia, stroke, or 30-day mortality observed after TEVAR. The median duration of follow-up was 30.0 months (range, 3-60). As the last follow-up CT angiography showed, most of the patients (23 in 24, 96%) had favorable aortic remodeling. The maximum hematoma thicknesses and maximum diameters of both ascending and descending aorta were significantly decreased. During follow-up, 1 patient developed retrograde type A aortic dissection (RAAD) and underwent open surgery 3 months after TEVAR. 1 patient died of lung cancer 2 years later. There was no aorta-related death observed. Conclusions: TEVAR provides a safe and effective treatment strategy for selected patients with retrograde type A IMH, and FID developed in descending aorta could be the possible treatment target. However, RAAD remains one of the most serious postoperative complications of concern.

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Section: Discussionsupporting

confidence: 60%

“…Several groups reported the application of TEVAR in type A IMH, mostly in case reports and small case series (23)(24)(25)(26). Grimm et al reported a series of 8 patients with type A IMH that were successfully treated with regular TEVAR (26).…”

Section: Discussionmentioning

confidence: 99%

Endovascular repair for retrograde type A intramural hematoma with focal intimal disruption in descending aorta

Li¹,

Zhang²,

Peng³

et al. 2021

J Thorac Dis

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show abstract

“…( 6 ), the most common diseases of the ascending aorta treated with TEVAR were dissection, followed by pseudoaneurysm, penetrating aortic ulcer, aortic rupture, and aneurysm. TEVAR for the treatment of IMH is relatively less common ( 7 , 8 ). Our patient had an exceedingly rare aortic syndrome of ascending aortic aneurysm of 6.5 cm, dissection, intramural hematoma, and pseudoaneurysm.…”

Section: Discussionmentioning

confidence: 99%

Pseudoaneurysm as a Late Complication of Chronic Stanford Type A Intramural Hematoma Requiring Endovascular Repair

et al. 2020

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Aortic intramural hematoma accounts for 5% to 20% of patients with acute aortic syndrome. Endovascular grafts have evolved as minimally invasive alternatives for treatment in some highly selected patients. We present the case of a patient who had late complications of a chronic Stanford type A intramural hematoma requiring thoracic endovascular aortic repair. ( Level of Difficulty: Beginner. )

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“…Evidence is growing that suggests some of these patients may be adequately treated with less-invasive initial management. 1 , 2 , 3 Nishi and colleagues 4 present a case of thoracic endovascular repair for acute retrograde type A aortic dissection (TAAD) and demonstrate its feasibility in the setting of acute spinal cord ischemia.…”

mentioning

confidence: 99%

“…Nonrandomized registry data of patients with acute retrograde TAAD analyzed by Nauta and colleagues 2 showed that those with limb ischemia and smaller ascending aortic diameters are more likely to be selected for endovascular repair and have comparable outcomes compared with surgically managed counterparts. The single-center experience of Chen and colleagues 3 also demonstrated that endovascular treatment of thrombosed retrograde TAAD or type A intramural hematoma is feasible with favorable early outcomes, although the sample size 6 six patients limits generalization of their outcomes. An additional dilemma is that most currently available data involve patients with spontaneous acute aortic injury, and the applicability of these results to patients with retrograde tears after previous endovascular aortic repair are unclear.…”

mentioning

confidence: 99%

Commentary: Working downstream: Distal endovascular repair for retrograde type A aortic dissection

Fryer

Balsam

2020

JTCVS Techniques

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Thoracic Endovascular Aortic Repair for Type A Intramural Hematoma and Retrograde Thrombosed Type A Aortic Dissection: A Single-Center Experience

Cited by 12 publications

References 18 publications

Endovascular repair for retrograde type A intramural hematoma with focal intimal disruption in descending aorta

Endovascular repair for retrograde type A intramural hematoma with focal intimal disruption in descending aorta

Pseudoaneurysm as a Late Complication of Chronic Stanford Type A Intramural Hematoma Requiring Endovascular Repair

Commentary: Working downstream: Distal endovascular repair for retrograde type A aortic dissection

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