Incidence and risk factors for retrograde type A dissection and stent graft-induced new entry after thoracic endovascular aortic repair

Ma, Tao; Dong, Zhi Hui; Fu, Wei; Guo, Da Qiao; Xu, Xiaowu; Chen, Bin; Jiang, Jun; Yang, Jing; Shi, Zhiyu; Zhu, Ting; Shi, Yijie; Jiang, Bao Hong; Xu, Xiao Yun

doi:10.1016/j.jvs.2017.08.070

Cited by 111 publications

(109 citation statements)

References 30 publications

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“…Some may be concerned with having a proximal graft with the bare stent configuration, although there are conflicting reports as to the effect of a proximal bare stent on RTAD rates. 16,19 A greater degree of oversizing is associated with an increased risk for RTAD, but the Society of Vascular Surgery has not reached a consensus on an optimal oversizing for TEVAR. 20 Other factors such as more angulated landing zones, a history of smoking, and hypertension have also been reported to be associated with increased RTAD rates.…”

Section: Discussionmentioning

confidence: 99%

“…20 Other factors such as more angulated landing zones, a history of smoking, and hypertension have also been reported to be associated with increased RTAD rates. 16,17,19 Further insights of the risk factors for Access artery complications are becoming a greater concern for endovascular solutions as the potential patient population to be treated with these devices is broadened. Women tend to have smaller and more tortuous access arteries, resulting in more frequent use of the iliac artery, which is associated with an increased risk for adverse events.…”

Section: Discussionmentioning

confidence: 99%

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Pivotal results for the Valiant Navion stent graft system in the Valiant EVO global clinical trial

Azizzadeh

Desai

Arko

et al. 2019

Journal of Vascular Surgery

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Objective: The Valiant Navion stent graft system (Medtronic, Santa Rosa, Calif) is a new iteration of a thoracic endograft for the treatment of descending thoracic aortic aneurysms. Herein, the 30-day primary safety and efficacy outcomes and secondary end points are presented. Methods:The Valiant EVO global clinical trial is a prospective, nonrandomized, single-arm trial. Patient enrollment occurred from April 2016 to October 2017. The primary end point was defined as access and/or deployment failure and/or a major device effect (MDE), including device-related secondary procedures, device-related mortality, conversion to open surgery, or thoracic aortic aneurysm rupture within 30 days of the index procedure. Other measures of stent graft performance including procedural data, rates of secondary procedures, and frequency of endoleaks are also reported.Results: Of the 87 consecutive patients undergoing thoracic endovascular aneurysm repair who were enrolled, 33 (37.9%) were female with 61 (70.9%) presenting with severe access artery tortuosity and 66 (85.7%) with high thoracic aortic tortuosity per core laboratory evaluation. The mean procedure duration was 88.7 6 53.4 minutes and geographical differences existed such as percutaneous access (37/52 [71.2%]) in the United States and surgical cut down in the outside of the U.S. sites (28/35 [80.0%]). There were no access or deployment failures and only 2.3% of the patients (2/87; P < .0001; performance goal of 16%) experienced a MDE within 30 days of the index procedure. Two secondary procedures (n ¼ 1 retrograde type A dissection; n ¼ 1 aortic arch rupture) were required, and in the first 30 days, two patients died leading to a freedom from all-cause mortality of 97.7%. Endoleaks at 1 month were reported in 2.5% of patients (n ¼ 1 type Ia; n ¼ 1 type II).Conclusions: Access/deployment failures, MDEs, and endoleaks were rare in the first 30 days of the Valiant Evo clinical trial. The Valiant Navion thoracic stent graft system has shown encouraging 30-day results in this challenging cohort and trial patients will continue to be followed through 5 years. (J Vasc Surg 2019;70:1399-408.)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pivotal results for the Valiant Navion stent graft system in the Valiant EVO global clinical trial

Azizzadeh

Desai

Arko

et al. 2019

Journal of Vascular Surgery

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“…However, the partial occlusion clamp may injure the fragile aortic wall (debranching procedure) and cause further damage that results in lethal complications . In addition, a dilated ascending aorta (>4 cm) (indicates inherent weakness of the aortic wall), TEVAR in the chronic phase, and bicuspid aortic valve disease (known to be associated with ascending aorta diseases) are potential risk factors for fatal complications after TEVAR . In death patients, 10 patients had a landing zone at the aortic arch (zones 0‐2), four patients underwent arch reconstruction, 13 of 14 patients who died had an ascending aorta larger than 4 cm, six patients received TEVAR in the chronic phase (>90 days), and six patients had bicuspid aortic valves (Supporting information 1).…”

Section: Discussionmentioning

confidence: 99%

The evolution of treatments for uncomplicated type B intramural hematoma patients

Jiang

Feng

et al. 2020

J Card Surg

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Objectives We aimed to investigate whether uncomplicated type B intramural hematoma (IMHB) patients with known evolution predictors could benefit from more aggressive therapy. Methods Retrospective analysis was performed in uncomplicated IMHB patients with evolution predictors between January 2001 and August 2018. Cox proportional hazard models were constructed to identify the specific factors associated with aorta‐related mortality. Results A total of 226 uncomplicated acute IMHB patients with evolution predictors were included. The conventional therapy group included 187 patients, and the other 39 patients received the more aggressive therapy. Aorta‐related mortality in the first year was higher in the conventional therapy group than in the more aggressive therapy group (15% vs 2.5%, P = .035), and more patients died after thoracic endovascular aortic repair (TEVAR) (13 of 27 patients, 48.1% vs 2.5%, P < .001). The more aggressive therapy group had a higher rate of hematoma resolution than the conventional therapy group (81.6% vs 62.2%, P = .024), a lower possibility of hematoma worsening (2.6% vs 17.0%, P = .021), and a lower reintervention rate (0% vs 11.9%, P = .028). Cox regression analysis revealed that a higher rate of focal intimal disruption (FID) development (hazard ratio [HR], 3.99; 95% confidence interval [CI], 1.16‐11.46, P = .010), and a higher C‐reactive protein (CRP) level (HR, 1.27; 95% CI, 1.16‐1.40, P < .001) were associated with increased aorta‐related mortality. Conclusions More aggressive therapy for uncomplicated IMHB patients with evolution predictors during the acute phase may result in better clinical outcomes. A higher rate of FID development and a higher CRP level are associated with increased aorta‐related mortality.

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“…Selecting the appropriate size of SG in this pathology is important. An oversized SG might result in formation of a new tear around the edge of the SG,4, 5, 6 and a smaller size of SG can result in type Ia or Ib leakage with treatment failure. Currently, no consensus has been reached as how to decide on the size of an SG in AAD.…”

Section: Discussionmentioning

confidence: 99%

“…In these situations increasing numbers of reports have demonstrated the beneficial effects of stent graft (SG) use in dissected descending aortic lesions 2, 3. However, devastating complications, such as retrograde type A dissection or formation of a new tear around the edge of an SG, have also been reported 4, 5, 6. One of the main factors involved in such disastrous complications is the use of an oversized SG for this pathology 6.…”

Section: Introductionmentioning

confidence: 99%

Equations for Estimating the Predissected Diameter of the Descending Aorta From Computed Tomographic Images at the Onset of Aortic Dissection

Yamauchi

Masai

Takano

et al. 2018

JAHA

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BackgroundEstimation of the predissected descending aortic diameter is important for deciding on the size of a stent graft in cases of acute aortic dissection. However, no equations for estimating this diameter have been previously reported.Methods and ResultsWe developed and validated new equations by investigating computed tomography images that were scanned within 3 years before dissection and those that were scanned immediately after the onset of dissection. Among 1127 patients with acute aortic dissection (425 type A and 702 type B), 36 were matched for the study from October 2005 to March 2017 at 4 centers. New equations were developed in 17 patients and validated in 19 patients. We measured the predissected whole circumference length (CL) and postdissected whole CL, true lumen CL, the major diameter, and the minor diameter of the acutely dissected aorta, followed by calculation of (post‐trueCL+post‐wholeCL)/2 and (post–major diameter+post—minor diameter)/2. Six equations (linear function) and modified equations were derived from each of the above‐mentioned parameters. In the derivation sets, equations that used the parameter of (post‐trueCL+post‐wholeCL)/2 were strongly correlated with pre‐wholeCL (Y=0.9433x+5.0147; R 2=0.9001) and showed significantly less bias compared with the other 5 equations (P<0.0001). In validation sets using this equation, the mean bias of the circumference length and diameter was 2.7±2.8 and 0.85±0.89 mm, respectively. A total of 99.2% of the calculated values were within 3 mm in diameter or less.ConclusionsOur newly developed equations can be used to calculate the predissected aortic diameter in cases of acute aortic dissection and might help to decide the size of the stent graft.

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Incidence and risk factors for retrograde type A dissection and stent graft-induced new entry after thoracic endovascular aortic repair

Abstract: The presence of a PBS is not associated with a higher RTAD rate, whereas the use of an SG with a connecting bar and length <165 mm increases the risk of RTAD and SINE after TEVAR.

Cited by 111 publications

References 30 publications

Pivotal results for the Valiant Navion stent graft system in the Valiant EVO global clinical trial

Pivotal results for the Valiant Navion stent graft system in the Valiant EVO global clinical trial

The evolution of treatments for uncomplicated type B intramural hematoma patients

Equations for Estimating the Predissected Diameter of the Descending Aorta From Computed Tomographic Images at the Onset of Aortic Dissection

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