Thoracic endovascular repair of chronic type B aortic dissection: a systematic review

Williams, Michael L.; Boer, Madeleine de; Hwang, Bridget; Wilson, Bruce; Brookes, John; McNamara, Nicholas; Tian, David H.; Shiraev, Timothy; Preventza, Ourania

doi:10.21037/acs-2021-taes-25

Cited by 13 publications

(10 citation statements)

References 82 publications

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“…Likewise, the positive aortic remodeling is shown by a 10% lower perfusion rate of the FL in the TEVAR patients (61%) compared with the conservatively treated patients (71%). Though aortic remodeling and thrombosis of the false lumen are crucial for positive long-term results, as proposed in a systematic review of 48 studies on endovascular cTBAD, many studies on this topic do not include quantifiable data on aortic remodeling [ 24 ]. Although not standardized, this difference in the perfusion rates in the FL of TEVAR patients compared to conservatively treated patients is very informative.…”

Section: Discussionmentioning

confidence: 99%

Complications in Patients with Chronic Type B Aortic Dissection (cTBAD)—A Long-Term Analysis

Mohajeri

Rammos

Tsagakis

et al. 2023

Life

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Chronic type B aortic dissection (cTBAD) is a rare but challenging condition that requires individual treatment strategies. Especially the long-term therapy impacts prognosis. In this single-center retrospective study, we evaluated patients with cTBAD in our vascular outpatient clinic over 10 years. Follow-up consultations included contrast-enhanced, electrocardiogram-triggered, high-resolution CT angiography (CTA) covering the entire aorta. Evaluated characteristics went beyond demographic characteristics combining the treatment approach and the timing and occurrence of potential complications. We analyzed 133 patients in total (n = 92, 69.2% male) with cTBAD with a mean follow-up of 67.7 months. Most of them underwent invasive treatment (n = 102, 76.7%), the majority received thoracic endovascular aortic repair (TEVAR) (n = 82, 61.7%). A total of 80 patients (60.2%) had major complications, whereas over a third was free of complications even after 5 years. Most common complications were progress of dissection and endoleaks, aneurysms of true (TL) and false lumen (FL) were more common in the later time periods. The treatment of cTBAD in terms of timing, therapy approach, and complications is still challenging for the entire aortic team. Nevertheless, the early recognition of complications permits promising treatment options and highlights the importance of frequent follow-up examinations especially within the first years.

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Section: Discussionmentioning

confidence: 99%

Complications in Patients with Chronic Type B Aortic Dissection (cTBAD)—A Long-Term Analysis

Mohajeri

Rammos

Tsagakis

et al. 2023

Life

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“…A 0D lumped parameter model of the vasculature (20-sim, Controllab Products, Netherlands) was used to calibrate three-element Windkessel (WK3) parameters (Fig 1c), used at the outlets as pressure boundary conditions in the CFD as described in previous works (Stokes et al, 2023b;Westerhof et al, 2009). Parameter values are displayed in Appendix 2.…”

Section: Pressure [Mmhg] Flow Rate [Ml/s]mentioning

confidence: 99%

Patient-specific compliant simulation framework informed by 4DMRI-extracted Pulse Wave Velocity: Application post-TEVAR

Girardin,

Lind,

von Tengg-Kobligk

et al. 2024

Preprint

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We introduce a new computational framework that makes use of the Pulse Wave Velocity (PWV) extracted exclusively from 4D flow MRI (4DMRI) to inform patient-specific compliant computational fluid dynamics (CFD) simulations of a Type-B aortic dissection (TBAD), post-thoracic endovascular aortic repair (TEVAR). From 4DMRI and brachial pressure, a 3D inlet velocity profile (IVP), dynamic outlet boundary, and reconstructed thoracic aortic geometry are obtained. A moving boundary method (MBM) is applied to simulate aortic wall displacement. The aortic wall stiffness was estimated through two methods: one relying on area-based distensibility and the other utilising regional pulse wave velocity (RPWV) distensibility, further fine-tuned to align with in vivo values. Predicted pressures and outlet flow rates were within 2.3% of target values. RPWV-based simulations were more accurate in replicating in vivo hemodynamic compared to the area-based ones. RPWVs were closely predicted in most regions, with the exception being the endograft, and systolic flow reversal ratios (SFRR) were accurately captured, while a difference of above 60% on in-plane rotational flow (IRF) between the simulations. Significant disparities between the wall shear stress (WSS)-based indices were observed between the two approaches, especially the endothelial cell activation potential (ECAP). At the isthmus, the RPWV-driven simulation indicated a mean ECAP>1.4Pa^(-1) (critical threshold), indicating areas potentially prone to thrombosis. In contrast, the area-based simulation did not depict this. RPWV-driven simulation results agree well with 4DMRI measurements, emphasising that RPWV simulations are accurate in simulating haemodynamics, consequently facilitating a comprehensive assessment of surgery decision-making and potential complications, such as thrombosis and aortic growth.

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“…Concerning chronic type B aortic dissections, almost 25–50% of patients with acute type B aortic dissection who were treated conservatively will require future treatment (surgical or endovascular) due to aneurysmal dilation of the chronically dissected thoracic aorta [ 43 ]. Chronic uncomplicated type B aortic dissection is initially treated with medical therapy along with clinical and imaging follow-up [ 44 ].…”

Section: Interventional Treatmentmentioning

confidence: 99%

“…However, complicated type B aortic dissections (CBAD), meaning those with rapid thoracic aortic enlargement (>10 mm/year), false lumen aneurysms (with a total aortic diameter of > 60 mm), recurrent pain, or malperfusion syndrome [ 1 ], require treatment, either surgical or endovascular. Aneurysmal dilatation and rapid aortic growth are the most frequent indications for treatment [ 43 ].…”

Section: Interventional Treatmentmentioning

confidence: 99%

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Chronic Thoracic Aortic Dissection: How to Treat, When to Intervene

Papakonstantinou

Benia

Polyzos

et al. 2022

Life

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Thoracic aortic dissection (AD) is associated with increased morbidity and mortality. Acute aortic syndrome is the first presentation of the disease in most cases. While acute AD management follows concrete guidelines because of its urgent and life-threatening nature, chronic AD is usually overlooked, although it concerns a wide spectrum of patients surviving an acute event. Acute AD survivors ultimately enter a chronic aortic disease course. Patients with chronic thoracic AD (CTAD) require lifelong surveillance and a proportion of them may present with symptoms and late complications demanding further surgical or endovascular treatment. However, the available data concerning the management of CTAD is sparse in the literature. The management of patients with CTAD is challenging as far as determining the best medical therapy and deciding on intervention are concerned. Until recently, there were no guidelines or recommendations for imaging surveillance in patients with chronic AD. The diagnostic methods for imaging aortic diseases have been improved, while the data on new endovascular and surgical approaches has increased significantly. In this review, we summarize the current evidence in the diagnosis and management of CTAD and the latest recommendations for the surgical/endovascular aortic repair of CTAD.

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Thoracic endovascular repair of chronic type B aortic dissection: a systematic review

Cited by 13 publications

References 82 publications

Complications in Patients with Chronic Type B Aortic Dissection (cTBAD)—A Long-Term Analysis

Complications in Patients with Chronic Type B Aortic Dissection (cTBAD)—A Long-Term Analysis

Patient-specific compliant simulation framework informed by 4DMRI-extracted Pulse Wave Velocity: Application post-TEVAR

Chronic Thoracic Aortic Dissection: How to Treat, When to Intervene

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