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Abstract

Purpose:

This study aimed to investigate the effect of distal aortic segmental enlargement (DASE) after thoracic endovascular aortic repair for complicated type B aortic dissection (cTBAD).

Materials and Methods:

From March 2003 to October 2018, 814 patients with acute cTBAD from 5 medical centers were retrospectively identified. DASE is indicated as the enlargement of distal aortic segmental volume ≥1.6 fold of the preoperative volume compared with the most recent postoperative computed tomography angiography (CTA) scan. Of these patients, 635 (78%) were identified as non-DASE, and 179 (22%) were identified as DASE. Competing risk analysis was performed to compare late death and distal aortic reintervention between the groups. The morphological variables and false lumen thrombosis at 7 aortic levels were measured based on the preoperative CTA and the most recent CTA. Univariate and multivariate Cox regression analyses were used to assess the independent predictors of DASE.

Results:

The mean follow-up time of the entire cohort was 5.6 years (interquartile range: 2.4–8.3 years). There were total of 208 late deaths, including 94 (14.8%) deaths in non-DASE group versus 114 (63.7%) deaths in the DASE group. Distal aortic reintervention was observed in 89 patients, with 43(6.7%) in the non-DASE group versus 46 (25.7%) in the DASE group. The cumulative incidence of late death and distal aortic reintervention were significantly higher in the DASE than in the non-DASE group (p<0.001). In morphological analysis, significant incomplete false lumen thrombosis was observed in all distal aortic segments above the aortic level of celiac artery (p<0.01). According to multivariate analysis, the Marfan syndrome, stent coverage to the level of diaphragm and the level of celiac artery were independent predictors of the DASE (p<0.001). Patients with extended stent coverage to the level of celiac artery have shown a lower incidence of DASE (p<0.010).

Conclusion:

Compared with the non-DASE group, patients with DASE demonstrated a higher rate of late death and distal aortic reintervention. For the cTBAD population, extended stent-graft coverage to the aortic section between diaphragm and celiac artery might serve as a “cost-efficient” cutoff point aiming to reduce the risk of DASE.

Keywords

complicated type B aortic dissection (cTBAD)thoracic endovascular aortic repair (TEVAR)distal aortic segmental enlargement (DASE)aortic remodeling false lumen thrombosis aortic dilation

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References

Nienaber

Yuan

Aboukoura

, et al. Improved remodeling with TEVAR and distal bare-metal stent in acute complicated type B dissection. Ann Thorac Surg. 2020;110:1572–1579. doi: 10.1016/j.athoracsur.2020.02.029

Spinelli

Weaver

Azizzadeh

, et al. Endovascular treatment of complicated versus uncomplicated acute type B aortic dissection. J Thorac Cardiovasc Surg. Published online January 21, 2021. doi: 10.1016/j.jtcvs.2021.01.027

Lombardi

Hughes

Appoo

, et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. J Vasc Surg. 2020;71:723–747. doi: 10.1016/j.jvs.2019.11.013

Fattori

Tsai

Myrmel

, et al. Complicated acute type B dissection: is surgery still the best option? A report from the International Registry of Acute Aortic Dissection. JACC Cardiovasc Interv. 2008;1:395–402. doi: 10.1016/j.jcin.2008.04.009

Spinelli

Benedetto

Donato

, et al. Current evidence in predictors of aortic growth and events in acute type B aortic dissection. J Vasc Surg. 2018;68:1925–1935.e1928. doi: 10.1016/j.jvs.2018.05.232

van Bogerijen

Tolenaar

Rampoldi

, et al. Predictors of aortic growth in uncomplicated type B aortic dissection. J Vasc Surg. 2014;59:1134–1143. doi: 10.1016/j.jvs.2014.01.042

Akutsu

Nejima

Kiuchi

, et al. Effects of the patent false lumen on the long-term outcome of type B acute aortic dissection. Eur J Cardiothorac Surg. 2004;26:359–366. doi: 10.1016/j.ejcts.2004.03.026

Trimarchi

Jonker

van Bogerijen

, et al. Predicting aortic enlargement in type B aortic dissection. Ann Cardiothorac Surg. 2014;3:285–291. doi: 10.3978/j.issn.2225-319X.2014.05.01

Qin

Deng

, et al. Risk factors of incomplete thrombosis in the false lumen after endovascular treatment of extensive acute type B aortic dissection. J Vasc Surg. 2012;56:1232–1238. doi: 10.1016/j.jvs.2012.04.019

10.

Nienaber

Kische

Rousseau

, et al. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv. 2013;6:407–416. doi: 10.1161/CIRCINTERVENTIONS.113.000463

11.

Conrad

Crawford

Kwolek

, et al. Aortic remodeling after endovascular repair of acute complicated type B aortic dissection. J Vasc Surg. 2009;50: 510–517. doi: 10.1016/j.jvs.2009.04.038

12.

Spanos

Kolbel

Rohlffs

, et al. Intentional targeted false lumen occlusion after aortic dissection: a systematic review of the literature. Ann Vasc Surg. 2019;56:317–329. doi: 10.1016/j.avsg.2018.08.086

13.

Patterson

Cobb

Karthikesalingam

, et al. A systematic review of aortic remodeling after endovascular repair of type B aortic dissection: methods and outcomes. Ann Thorac Surg. 2014;97:588–595. doi: 10.1016/j.athoracsur.2013.07.128

14.

Dake

Thompson

van Sambeek

, et al. DISSECT: a new mnemonic-based approach to the categorization of aortic dissection. Eur J Vasc Endovasc Surg. 2013;46:175–190. doi: 10.1016/j.ejvs.2013.04.029

15.

Nienaber

Clough

. Management of acute aortic dissection. Lancet. 2015;385:800–811. doi: 10.1016/S0140-6736(14)61005-9

16.

Liu

Feng

, et al. Total endovascular repair with parallel stent-grafts for postdissection thoracoabdominal aneurysm after prior proximal repair. J Endovasc Ther. 2019:1526602819863779. doi: 10.1177/1526602819863779

17.

Yang

Zhang

, et al. Endovascular repair of post-dissection aortic aneurysms using physician-modified endografts. Ann Thorac Surg. Published online December 4, 2020. doi: 10.1016/j.athoracsur.2020.11.016

18.

Lombardi

Hughes

Appoo

, et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. Ann Thorac Surg. 2020;109:959–981. doi: 10.1016/j.athoracsur.2019.10.005

19.

Tsai

Evangelista

Nienaber

, et al. Partial thrombosis of the false lumen in patients with acute type B aortic dissection. N Engl J Med. 2007;357:349–359. doi: 10.1056/NEJMoa063232

20.

Bernard

Zimmermann

Chocron

, et al. False lumen patency as a predictor of late outcome in aortic dissection. Am J Cardiol. 2001;87:1378–1382.

21.

Trimarchi

Tolenaar

Jonker

, et al. Importance of false lumen thrombosis in type B aortic dissection prognosis. J Thorac Cardiovasc Surg. 2013;145:S208–S212. doi: 10.1016/j.jtcvs.2012.11.048

22.

Lortz

Leinburger

Tsagakis

, et al. Distal stent graft induced new entry: risk factors in acute and chronic type B aortic dissections. Eur J Vasc Endovasc Surg. 2019;58:822–830. doi: 10.1016/j.ejvs.2019.04.015

23.

Czerny

Schmidli

Bertoglio

, et al. Clinical cases referring to diagnosis and management of patients with thoracic aortic pathologies involving the aortic arch: a companion document of the 2018 European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) expert consensus document addressing current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch. Eur J Cardiothorac Surg. 2019;55:163–171. doi: 10.1093/ejcts/ezy383

24.

Akin

Kische

Rehders

, et al. Thoracic endovascular stent-graft therapy in aortic dissection. Curr Opin Cardiol. 2010;25:552–559. doi: 10.1097/HCO.0b013e32833e6dd8

25.

Kret

Azarbal

Mitchell

, et al. Compliance with long-term surveillance recommendations following endovascular aneurysm repair or type B aortic dissection. J Vasc Surg. 2013;58:25–31. doi: 10.1016/j.jvs.2012.12.046

26.

Bossone

LaBounty

Eagle

. Acute aortic syndromes: diagnosis and management, an update. Eur Heart J. 2018;39:739–749d. doi: 10.1093/eurheartj/ehx319

27.

Higashigaito

Sailer

van Kuijk

SMJ

, et al. Aortic growth and development of partial false lumen thrombosis are associated with late adverse events in type B aortic dissection. J Thorac Cardiovasc Surg. 2019;161:1184–1190. doi: 10.1016/j.jtcvs.2019.10.074

28.

Kirsch

Legras

Bruzzi

, et al. Fate of the distal aorta after surgical repair of acute DeBakey type I aortic dissection: a review. Arch Cardiovasc Dis. 2011;104:125–130. doi: 10.1016/j.acvd.2010.11.009

29.

Zhang

Chen

Zhang

, et al. Should the distal tears of aortic dissection be treated? The risk of distal tears after proximal repair of aortic dissection. Int J Cardiol. 2018;261:162–166. doi: 10.1016/j.ijcard.2018.01.028

30.

Liu

Zhang

Feng

, et al. Unplanned stents in thoracic endovascular aortic repair for type B aortic dissection: a 16-year single-center report. Vascular. 2018;26:400–409. doi: 10.1177/1708538117746555

31.

Evangelista

Isselbacher

Bossone

, et al. Insights from the international registry of acute aortic dissection: a 20-year experience of collaborative clinical research. Circulation. 2018;137:1846–1860. doi: 10.1161/CIRCULATIONAHA.117.031264

32.

Qiu

Zha

Zhang

, et al. A meta-analysis of combined proximal stent grafting with or without adjunctive distal bare stent for the management of aortic dissection. J Vasc Surg. 2020;72:1109–1120 e1106. doi: 10.1016/j.jvs.2020.02.052

33.

Xue

, et al. Association between extent of stent-graft coverage and thoracic aortic remodeling after endovascular repair of type B aortic dissection. J Endovasc Ther. 2020;27: 211–220. doi: 10.1177/1526602820904164

34.

Eggebrecht

Nienaber

Neuhauser

, et al. Endovascular stent-graft placement in aortic dissection: a meta-analysis. Eur Heart J. 2006;27:489–498. doi: 10.1093/eurheartj/ehi493

35.

Lou

Duwayri

Jordan

Jr , et al. The safety and efficacy of extended TEVAR in acute type B aortic dissection. Ann Thorac Surg. 2020;110:799–806. doi: 10.1016/j.athoracsur.2019.12.036

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Extended Stent Coverage Decreases Distal Aortic Segmental Enlargement After the Endovascular Repair of Acute Complicated Type B Aortic Dissection: A Multi-Center Retrospective Study of 814 Patients

Abstract

Purpose:

Materials and Methods:

Results:

Conclusion:

Keywords

Get full access to this article

References

Supplementary Material