Extended thoracic endovascular aortic repair for residual aortic dissection after type A aortic dissection repair

Abstract

Objective We investigated the outcomes of extended coverage of the descending thoracic aorta by thoracic endovascular aortic repair (TEVAR) for residual chronic type B aortic dissection after type A aortic dissection (TAAD) repair. Methods From November 2015 to August 2020, 36 patients underwent extended TEVAR for residual intimal tear after TAAD repair. We specifically investigated the methods and outcomes of this procedure. Results TEVAR consisted of isolated TEVARs ( n = 29), single-vessel debranching TEVAR (6), and two-vessel debranching TEVAR (1). The mean time from TAAD repair to TEVAR was 27 ± 33 months (2–86 months). The TEVAR devices used were Valiant (28 cases), GORETAG (4), Relay plus (2), and TX2 (2). Technical success of TEVAR was 100%. The distal ends of the stent grafts were T 8 (1 case), T 9 (5), T 10 (6), T 11 (9), and T 12 (15), with an average of T 11 ± 1. The average length of hospital stay after TEVAR was 9 ± 3 days (5–17 days). There were no surgical/hospital deaths or complications. The average postoperative follow-up period was 21 ± 15 months without death or reintervention. Conclusions The short-term outcomes of extended TEVAR for residual chronic type B aortic dissection after TAAD repair were acceptable without perioperative SCI. Aggressive descending thoracic aorta coverage may prevent aortic events, and extended TEVAR may be a preemptive treatment for the downstream aorta. Mid- to long-term results should be clarified.

Investigation of factors affecting reintervention after type A aortic dissection

“…In their study, Iida et al examined the conditions and consequences of TEVAR procedure performed for residual aortic dissection after TAAD [19]. They showed that after total arch surgery and elephant trunk procedure in the first operation of 52.8% of the patients, >55-60mm distal aortic diameter, >5mm aortic diameter enlargement in 6 months, postoperative true lumen stenosis and intimal tear in the descending thoracic aorta were the cause of reintervention.…”