Type A Dissection Following Endovascular Thoracic Aortic Stent-Graft Repair

Neuhauser, Beate; Czermak, Benedikt V.; Fish, John; Perkmann, Reinhold; Jaschke, Werner; Chemelli, Andreas; Fraedrich, Gustav

doi:10.1583/04-1369.1

Cited by 97 publications

(69 citation statements)

References 30 publications

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“…However, the stronger the radial force is, the higher the risk of injury on the aortic wall is. By reviewing the published articles, 3,7-33 we found 37 patients who experienced RTAD after endografting for type B dissection; a stent graft with a proximal bare spring was used in at least 27 patients (73.0%), 7-10,14 -17,19 -25,30 an endoprosthesis without a bare stent was implanted in 2 patients, 13,33 and the type of device was unavailable in the remaining 8 patients. In our series, a prosthesis with a proximal bare spring was used in all 11 patients.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2009

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Background-Retrograde type A aortic dissection has been deemed a rare complication after endovascular stent graft placement for type B dissection. However, this life-threatening event appears to be underrecognized and is worth being investigated further. Methods and Results-Eleven of 443 patients developed retrograde type A aortic dissection during or after stent grafting for type B dissection from August 2000 to June 2007. Of these 11 patients, 3 had Marfan syndrome. The Kaplan-Meier estimate of the rate of freedom from this event at 36 months is 97.4% (95% confidence interval, 0.95 to 0.99). The new entry was located at the tip of the proximal bare spring of the stent graft in 9 patients, was within the anchoring area of the proximal bare spring in 1, and remained unknown in 1 patient. Eight patients were converted to open surgery, and 2 received medical treatment. One patient suddenly died 2 hours after the primary stent grafting, and 2 died within 1 week after the surgical conversion, so mortality reached 27.3%. During the follow-up from 3 to 50 months, type I endoleak was identified in 1 patient 3 months after the surgical exploration and disappeared at 6 months. Conclusions-Retrograde type A aortic dissection after stent grafting for type B dissection appears not to be rare and results from mixed causes. Fragility of the aortic wall and disease progression may predispose to it, whereas stent grafting-related factors make important and provocative contributions. Avoiding aortic arch stent grafting in Marfan patients, preferably selecting the endograft without the proximal bare spring for patients with a kinked aortic arch or with Marfan syndrome (if endografting is used), improving the device design, and standardizing endovascular manipulation might lessen its occurrence.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2009

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“…128,129 These patients are at higher risk for TEVAR-related complications such as retrograde dissection and stent-graftinduced new entry tears. 73,74,96,97,130 For TBAD patients with Ehlers-Danlos or Loeys-Dietz syndrome there are currently no data, besides a few case reports, to support any use of TEVAR, except in emergency situations to achieve hemodynamic stabilization as a bridge to definitive surgical therapy. 21,131,132 …”

Section: Chronic Treatmentmentioning

confidence: 99%

Update in the management of type B aortic dissection

et al. 2016

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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.

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“…Injury of the aortic wall in this part of aorta may have fatal consequences such as a retrograde type A aortic dissection (RAAD) or aortic rupture. The incidence of RAAD following TEVAR has been reported to be between 1.3% and 6.8% (9)(10)(11).…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

Thoracic endovascular repair for acute type A aortic dissection: operative technique

Shah

Khoynezhad

2016

Ann. Cardiothorac. Surg.

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Type A Dissection Following Endovascular Thoracic Aortic Stent-Graft Repair

Abstract: Endovascular stent-graft repair of the thoracic aorta is associated with lower morbidity and mortality rates than surgical repair, although potentially lethal complications, acute or delayed, may occur.

Cited by 97 publications

References 30 publications

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

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

Update in the management of type B aortic dissection

Thoracic endovascular repair for acute type A aortic dissection: operative technique

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