Landing Zone Remodelling after Endovascular Repair of Dissected Descending Aorta

Berkarda, Zeynep; Kondov, Stoyan; Kreibich, Maximilian; Czerny, Martin; Beyersdorf, Friedhelm; Rylski, Bartosz

doi:10.1016/j.ejvs.2020.02.007

Cited by 13 publications

(16 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, TEVAR with standard thoracic platforms in the setting of CTBAD carries a significant risk of dSINE, 6 which in turn may lead to aneurysm expansion, and warrant re-intervention. [7][8][9][10] Furthermore, dSINE have been lately recognized as a potential complication also following deployment of FET devices in patients undergoing proximal repair for type A dissection 11 , 12 (as noted in 2 patients from the present series).…”

Section: Discussionmentioning

confidence: 64%

Early Experience With a Novel Dissection-Specific Stent-Graft to Prevent Distal Stent-Graft-Induced New Entry Tears After Thoracic Endovascular Repair of Chronic Type B Aortic Dissections

Burdess

D’Oria

Mani

et al. 2022

Annals of Vascular Surgery

View full text Add to dashboard Cite

Background:The aim was to repor t shor t and mid-term outcomes of a novel, investigational, dissection-specific stent-graft (DSSG), specifically designed to address the features of chronic type B aortic dissection (CTBAD) and reduce the risk of distal stent-graft-induced new entry tears (dSINE). Materials and Methods:A retrospective single center cohort study of all patients undergoing TEVAR with the DSSG for CTBAD from January 1, 2017 to January 31, 2020. The DSSG, which is a modified stent-graft based on the Cook Zenith Alpha Thoracic platform, has no proximal barbs, and a customized longer body length with substantial taper. The second and third distal Zstents are sited internally to avoid any contact of the metal skeleton with the dissection membrane and have reduced radial force, while the most distal stent was removed creating a distal 30 mm unsupported Dacron graft. Results: Sixteen patients (13 males, 3 females) with a median age of 66 years (range 31-79 years) underwent elective TEVAR of CTBAD using the DSSG. Six patients (38%) had an underlying connective tissue disorder. The median tapering was 10 mm (range 4 mm-21 mm) and median length 270 mm (range 210-380 mm). Technical success was achieved in all but one case (96%). One patient died within 30 days, due to retrograde type A dissection with cardiac tamponade. The 30-day rate of stroke, spinal cord ischemia, and re-interventions was 0%. After median imaging follow-up time of 17 months (range 1-31 months), one patient developed a dSINE 4 months after the index procedure. After median survival follow-up of 23 months (range 2-35 months), one late death occurred due to traumatic brain injury, while no aortic-related death occurred during follow-up. Complete false lumen (FL) thrombosis was achieved in 9 patients while the remaining 6 showed partial FL thrombosis. No instances of diameter increase at the level of

show abstract

Section: Discussionmentioning

confidence: 64%

Early Experience With a Novel Dissection-Specific Stent-Graft to Prevent Distal Stent-Graft-Induced New Entry Tears After Thoracic Endovascular Repair of Chronic Type B Aortic Dissections

Burdess

D’Oria

Mani

et al. 2022

Annals of Vascular Surgery

View full text Add to dashboard Cite

show abstract

“…It could only be shown that excessive oversizing with respect to the true lumen diameter at the distal landing zone can lead to dSine and increased risk of aneurysm formation with subsequent rupture. Since 80% of the cases are treated with a distal landing zone of TEVAR in the dissected aorta [24], the use of tapered stent grafts to avoid excessive oversizing is recommended [6][7][8][9]25].…”

Section: Discussionmentioning

confidence: 99%

Influence of measurement and sizing techniques in thoracic endovascular aortic repair on outcome in acute complicated type B aortic dissections

Rychla

Dueppers

Meuli

et al. 2021

Interactive CardioVascular and Thoracic Surgery

View full text Add to dashboard Cite

OBJECTIVES Thoracic endovascular aortic repair (TEVAR) is the first-line therapy in acute complicated type B aortic dissections (cTBAD). Nevertheless, no evidence-based consensus on the optimal measurement technique and sizing for TEVAR in cTBAD exists. The aim was to evaluate how different measurement and sizing techniques for TEVAR affect long-term outcomes. METHODS Retrospective analysis investigating the association between sizing and postoperative results after TEVAR in patients with cTBAD, treated between January 2003 and December 2020. Diameter measurements were performed perpendicular to a centreline in pre-interventional Computed tomography angiographies. Oversizing was determined by measuring aortic diameter in zone 2 of the aortic arch in relation to the implanted stent graft, and categorized into 2 sizing groups (≤10% and >10%). The primary outcome was freedom from aortic-related events. Secondary outcomes included mortality and a comparison of 3 alternative measurement techniques considering the estimated pre-dissection diameter. RESULTS Fifty-seven patients (median age 69, interquartile range 59.6–78.2 years) were included. Stent graft oversizing by ≤10% showed a trend towards fewer aortic-related events hazard ratio 0.455 (95% confidence interval 0.128–1.624, P = 0.225). The 3 measurement techniques using the pre-dissection aortic diameter differed by a mean of 1.7–4.0 mm with a variability of up to 8.4 mm. In none of the 57 patients, the same stent graft would have been chosen based on the different measurement techniques using an oversizing ≤10%. CONCLUSIONS TEVAR oversizing of ≤10% in patients with cTBAD might reduce aortic-related events up to 50%. Consensus on measurement techniques of the pre-dissection aortic diameter and stent graft sizing is of paramount importance.

show abstract

“…Endoleak was an independent risk factor for early death and was the main cause of death after TEVAR during the long‐term follow‐up 16–18 . Berkarda et al found that the distal landing zone was dissected in 84% of the patients, and the diameter of the dissected distal landing zones measured for the true lumen and the entire aorta had increased by 7 and 4 mm, respectively, 1 year after TEVAR 19 . The long‐term mortality was also remarkably high in our series, and 5 of the 21 patients died suddenly during the follow‐up period.…”

Section: Discussionmentioning

confidence: 99%

Analysis of clinical outcomes of one‐staged hybrid procedure without thoracotomy for aorta lesion involving distal aortic arch

et al. 2021

View full text Add to dashboard Cite

Background This study aimed to evaluate the clinical outcomes of one‐staged hybrid procedure for aortic lesions involving the distal aortic arch. Methods We retrospectively studied 99 consecutive patients who underwent the hybrid procedure (thoracic endovascular aortic repair combined with supra‐arch branch vessel bypass) in our center between April 2009 and January 2020 for lesions involving the distal aortic arch. Results Median age was 64.0 (57.0–69.0) years, and 83 (83.8%) patients were male. There were five deaths in the perioperative period (three due to cerebral infarction and two due to intimal rupture). During the median follow‐up of 41.0 months, 20 patients died, three had endoleak, one had a newly formed intimal tear, and two had femoral artery pseudoaneurysm. The 5‐ and 10‐year survival rates of the total population were 72.2% and 48.8%, respectively. Additionally, there was no difference in the 5‐year survival rate among the four groups according to different pathologies (Type B aortic dissection, aortic ulcer, aortic aneurysm, aortic pseudoaneurysm: 74.7%, 78.2%, 61.1%, and 75.5%, respectively, p = .58). Furthermore, there was no difference in the 5‐ and 10‐year survival rates between the two groups according to the different bypass methods (right axillary artery [RAA]‐left axillary artery [LAA] vs. RAA‐LAA‐left common carotid artery: 74.1% vs. 68.9%, p = .38). Conclusions Although one‐staged hybrid procedure has fewer complications in high‐risk patients with lesions involving the distal aortic arch, the long‐term survival rate is not optimistic.

show abstract

Landing Zone Remodelling after Endovascular Repair of Dissected Descending Aorta

Cited by 13 publications

References 21 publications

Early Experience With a Novel Dissection-Specific Stent-Graft to Prevent Distal Stent-Graft-Induced New Entry Tears After Thoracic Endovascular Repair of Chronic Type B Aortic Dissections

Early Experience With a Novel Dissection-Specific Stent-Graft to Prevent Distal Stent-Graft-Induced New Entry Tears After Thoracic Endovascular Repair of Chronic Type B Aortic Dissections

Influence of measurement and sizing techniques in thoracic endovascular aortic repair on outcome in acute complicated type B aortic dissections

Analysis of clinical outcomes of one‐staged hybrid procedure without thoracotomy for aorta lesion involving distal aortic arch

Contact Info

Product

Resources

About