Serious complications following endovascular thoracic aortic stent-graft repair for type B dissection

Neuhauser, Beate; Greiner, Andreas; Jaschke, Werner; Chemelli, Andreas; Fraedrich, Gustav

doi:10.1016/j.ejcts.2007.10.010

Cited by 142 publications

(94 citation statements)

References 23 publications

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“…The third patient had a preexisting retrograde propagation of the dissection into the arch and a natural fenestration at the origin of the left common carotid artery, which did not resolve with embolization of the LSCA and adjacent aortic false lumen. This patient and 3 others underwent elective surgical repair at 8,8,6, and 3 months after stent-graft treatment, all of which were successful in removing endoleak-related dilatation.…”

Section: Resultsmentioning

confidence: 98%

“…1,2 Goals of stent-graft placement are to reestablish arterial flow to ischemic beds and to abolish pulsatile antegrade perfusion of the false lumen, which should reduce subsequent false lumen enlargement and rupture. [3][4][5][6][7][8] Continued pressurization and perfusion of the false lumen due to endoleak, however, is frequently seen after stent-graft repair of aortic dissection. 9,10 Compared with endoleaks encountered after thoracic endovascular aneurysm repair, endoleak physiology in aortic dissection is complex and incompletely understood.…”

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confidence: 99%

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Factors Portending Endoleak Formation After Thoracic Aortic Stent-Graft Repair of Complicated Aortic Dissection

Sze

Bosch

Dake

et al. 2009

Circ: Cardiovascular Interventions

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Background-Endoleaks after stent-graft repair of aortic dissections are poorly understood but seem substantially different from those seen after aneurysm repair. We studied anatomic and clinical factors associated with endoleaks in patients who underwent stent-graft repair of complicated type B aortic dissections. Methods and Results-From 2000 to 2007, 37 patients underwent stent-graft repair of acute (Յ14 days; nϭ23), subacute (15 to 90 days; nϭ10) or chronic (Ͼ90 days; nϭ4) complicated type B aortic dissections using the Gore Thoracic Excluder (nϭ17) or TAG stent-grafts (nϭ20) under an investigator-sponsored protocol. Endoleaks were classified as imperfect proximal seal, flow through fenestrations or branches, or complex (both). Variables studied included coverage of the left subclavian artery, aortic curvature, completeness of proximal apposition, dissection chronicity, and device used. Endoleaks were found during follow-up (mean, 22 months) in 59% of patients, and they were associated with coverage of the left subclavian artery (complex, PϽ0.001), small radius of curvature (type 1 and complex, Pϭ0.05), and greatest length of unapposed proximal stent graft (complex, PϽ0.0001). During follow-up, 10 endoleaks resolved spontaneously, 6 required reintervention for false lumen dilatation, and 2 were stable without clinical consequences. Conclusions-Endoleaks are common after stent-graft repair of aortic dissection and may lead to false lumen enlargement necessitating reintervention. Anatomic complexities such as acute aortic curvature and covered side branches were associated with endoleaks, illustrating the need for dissection-specific device development.

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Section: Resultsmentioning

confidence: 98%

mentioning

confidence: 99%

Factors Portending Endoleak Formation After Thoracic Aortic Stent-Graft Repair of Complicated Aortic Dissection

Sze

Bosch

Dake

et al. 2009

Circ: Cardiovascular Interventions

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“…Suitable patients should be hemodynamically stable and the ascending aortic FL thrombosed while the ascending aorta is preferably not severely dilated (ie, <5.5 cm). Recently, there has been a plethora of studies on retro-A AD occurring secondarily to thoracic endovascular aortic repair, [8][9][10] but the literature on spontaneous acute retro-A AD, which is a distinct entity, is limited. Previous studies were mostly conducted on small patient cohorts or mentioned through case reports.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Acute Retrograde Type A Aortic Dissection With an Entry Tear in Descending Aorta

et al. 2014

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Background-Optimal management strategy of acute aortic dissection (AD) with retrograde extension from entry tear in the descending aorta into the ascending aorta remains undetermined. Methods and Results-Of the 538 patients who were diagnosed as having acute AD from 1999 through 2011, 49 patients (37 men; 52.5±13.1 years) were identified as having entry tear in the descending aorta with retrograde extension of AD into the ascending aorta. Sixteen patients who were clinically stable with thrombosed false lumen in the ascending aorta were treated medically (MED group), whereas 33 patients underwent aortic replacement (SURG group) on an intentionto-treat basis. In the MED group, 1 patient was converted to urgent aortic surgery and 2 patients underwent endovascular stent grafting in the descending aorta during the initial hospitalization. The early (30-day or in-hospital) mortality rates were 0% and 9.1% in the MED and SURG group, respectively (P=0.54).

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“…12 Fourth, retrograde Stanford A dissection is the serious complication of TEVAR for AAD(B). 13 Fifth, although long-term results have not yet been established, Khoynezhad et al reported 1-and 5-year survival rates of 82% and 78%, respectively. 14 Vorhoye et al reported 1-and 5-year survival rates of 73% for each and that the false lumen was completely thrombosed in 25% patients and partially thrombosed in 38%.…”

Section: Discussionmentioning

confidence: 96%

“…15 A patent false lumen is a risk factor for long-term survival; therefore, a thrombosed false lumen suggests good long-term results. However, a catastrophic complication, retrograde Stanford A dissection, could occur even days, weeks, or months following TEVAR 13 . Therefore careful follow-up is mandatory.…”

Section: Discussionmentioning

confidence: 99%

Endovascular management for ruptured Stanford B acute aortic dissection

Aoki

Suezawa

Sangawa

et al. 2011

Gen Thorac Cardiovasc Surg

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Surgery for a complicated Stanford B acute aortic dissection, such as rupture or malperfusion, is still a challenge. We undertook endovascular therapy for ruptured Stanford B acute aortic dissection in two patients. A homemade stent graft was deployed in an 84-year-old woman with a massive mediastinal hematoma; and an aortic extender of Excluder was used for a 76-year-old man with left hemothorax. Both patients recovered without major complications. Careful follow-up is mandatory. Endovascular therapy for a ruptured Stanford B acute aortic dissection seems feasible and efficient.

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Serious complications following endovascular thoracic aortic stent-graft repair for type B dissection

Abstract: Endovascular stent-graft repair of the thoracic aorta is an alternative to surgical repair, however not without significant morbidity and mortality. Potentially lethal complications, acute or delayed, may occur.

Cited by 142 publications

References 23 publications

Factors Portending Endoleak Formation After Thoracic Aortic Stent-Graft Repair of Complicated Aortic Dissection

Factors Portending Endoleak Formation After Thoracic Aortic Stent-Graft Repair of Complicated Aortic Dissection

Outcomes of Acute Retrograde Type A Aortic Dissection With an Entry Tear in Descending Aorta

Endovascular management for ruptured Stanford B acute aortic dissection

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