“…In the case of CDIIIb aneurysms, both the presence of a stiff dissection flap and the inability to seal off the false lumen (FL) distally have been suggested as factors that may cause failure in TEVAR procedures. Indeed, TEVAR for CDIIIb aneurysms has previously exhibited unfavorable complete thrombosis rates (30% to 60%) [7][8][9]. Furthermore, we have previously used aggressive TEVAR while ensuring the sufficiency of the proximal landing zone and extending the stent graft to the level of the celiac trunk, but observed a complete thrombosis rate of only 65% for CDIIIb aneurysms [1].…”
“…In the case of CDIIIb aneurysms, both the presence of a stiff dissection flap and the inability to seal off the false lumen (FL) distally have been suggested as factors that may cause failure in TEVAR procedures. Indeed, TEVAR for CDIIIb aneurysms has previously exhibited unfavorable complete thrombosis rates (30% to 60%) [7][8][9]. Furthermore, we have previously used aggressive TEVAR while ensuring the sufficiency of the proximal landing zone and extending the stent graft to the level of the celiac trunk, but observed a complete thrombosis rate of only 65% for CDIIIb aneurysms [1].…”
“…Given that a thrombosed false lumen predicts lower event rates with type B-AAD (7) and favorable false lumen remolding after TEVAR for type B aortic dissection (8)(9)(10), TEVAR has also been used in patients with uncomplicated type B-AAD to reduce late morbidity and mortality (8,11,12). Recently, several studies have compared early and late outcomes of TEVAR and BMT in patients with type B-AAD (8,(11)(12)(13)(14)(15)(16).…”
This study confirmed the feasibility of TEVAR for uncomplicated type B aortic dissection in the acute setting with fewer aortic-related adverse events and a lower mortality rate compared with BMT.
“…A higher degree of total false lumen thrombosis has been demonstrated in type IIIA patients after TEVAR, as well as along the stented segment in type IIIB. 21 The PETTICOAT concept, 22 using a pathology specific device with proximal stent graft and distal bare metal stent, has been described as a potential adjunct in complex distal dissection involving the abdominal aorta. The FLA may be a better proxy for flow in the false lumen than the diameter, and it may also be less susceptible to inter-observer variation than diameter measurement.…”
All the early deaths demonstrated a FLA >50% of the total aortic cross sectional area at the level of the tracheal bifurcation. Patients needing urgent TEVAR had markedly worse outcome. The first finding may become an additional tool for future risk stratification.
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