Retrograde Type A Aortic Dissection After Endovascular Stent Graft Placement for Treatment of Type B Dissection

Dong, Zhi Hui; Fu, Wei; Wang, Yuqi; Guo, Da Qiao; Xu, Xiaowu; Ji, Yuan; Chen, Bin; Jiang, Jun; Yang, Jing; Shi, Zhiyu; Zhu, Ting; Shi, Yijie

doi:10.1161/circulationaha.107.759076

Cited by 257 publications

(236 citation statements)

References 39 publications

Supporting

Mentioning

223

Contrasting

Unclassified

Order By: Relevance

“…Device 'oversizing' in TBAD patients remains a topic of debate as it is associated with severe complications such as stent-graft-induced new entry tears, retrograde type A dissection, and proximal neck dilatation with subsequent stent-graft migration. [73][74][75][76] In general, oversizing by no more than 0-10% is recommended for patients with TBAD. 74,77 Mis-sizing of the stent-graft can be avoided by keeping in mind the dynamic behavior of the aorta.…”

Section: Endovascular Procedures Tevar (Thoracic Endovascular Aortic mentioning

confidence: 99%

Update in the management of type B aortic dissection

et al. 2016

View full text Add to dashboard Cite

Stanford type B aortic dissection (TBAD) is a life-threatening aortic disease. The initial management goal is to prevent aortic rupture, propagation of the dissection, and symptoms by reducing the heart rate and blood pressure. Uncomplicated TBAD patients require prompt medical management to prevent aortic dilatation or rupture during subsequent follow-up. Complicated TBAD patients require immediate invasive management to prevent death or injury caused by rupture or malperfusion. Recent developments in diagnosis and management have reduced mortality related to TBAD considerably. In particular, the introduction of thoracic stent-grafts has shifted the management from surgical to endovascular repair, contributing to a fourfold increase in early survival in complicated TBAD. Furthermore, endovascular repair is now considered in some uncomplicated TBAD patients in addition to optimal medical therapy. For more challenging aortic dissection patients with involvement of the aortic arch, hybrid approaches, combining open and endovascular repair, have had promising results. Regardless of the chosen management strategy, strict antihypertensive control should be administered to all TBAD patients in addition to close imaging surveillance. Future developments in stent-graft design, medical therapy, surgical and hybrid techniques, imaging, and genetic screening may improve the outcomes of TBAD patients even further. We present a comprehensive review of the recommended management strategy based on current evidence in the literature.

show abstract

Section: Endovascular Procedures Tevar (Thoracic Endovascular Aortic mentioning

confidence: 99%

Update in the management of type B aortic dissection

et al. 2016

View full text Add to dashboard Cite

show abstract

“…the incidence of this complication, according to existing data, ranges presumably between 1 and 2% and generally occurs shortly after the intervention [30,31]. Chest pain or symptoms of an ischemic heart or brain should immediately alert the suspicion that a Type B dissection has modiied itself to a Type A dissection, with a higher morbidity and mortality risk.…”

Section: Retrograde Type a Dissection Following Stent-graft Placementmentioning

confidence: 99%

Role of Interventional Treatment of Thoracic Aorta

Akın¹,

Ansari²,

Nienaber³

2017

Aortic Aneurysm

View full text Add to dashboard Cite

An aging western and oriental population coupled with breakthrough advances in modern diagnostic imaging modalities has evoked renewed interest in the hitherto underdiagnosed acute and chronic diseases of the aorta, which also include aortic aneurysm and aortic dissection. Although classical surgical strategies still dominate the clinical management of acute and chronic pathologies of the ascending aorta and the proximal arch region, the emergence of novel endovascular concepts has ofered an interesting therapy alternative for the treatment of descending aortic pathology in suitable patients and is highly likely to evolve as the primary treatment strategy in majority of the cases. Moreover, the use of hybrid approaches combining surgical head-vessel debranching and interventional stent-graft implantation in an atempt to improve clinical outcome in aortic arch pathologies has helped avoid the high risk of open arch repair or complete replacement. Notwithstanding these recent advancements, the complex nature of the underlying vascular disease still dictates that the proposed management of every diagnosed patient is discussed in a team constituting cardiologists, cardiac surgeons, anesthesiologists, and radiologists, with the conceptualization of individualized therapeutic strategies and conducted in a center with signiicant surgical and endovascular experience.

show abstract

“…When passively bent at the arch, the self-expanding endoprosthesis has the inherent tendency to spring back to its initial straight shape. Such spring-back strength could create a new entry at one or both ends [9]. In this case, we speculate the patient died of retrograde type A dissection, because he suddenly deteriorated and a massive amount of uncoagulable blood was drained from the pericardium.…”

Section: Case Reportmentioning

confidence: 86%