Elsa M Faure1, Ludovic Canaud2, Camille Agostini3, Roxane Shaub3, Gudrun Böge4, Charles Marty-ané4, Pierre Alric2. 1. Department of Thoracic and Vascular Surgery, University Hospital, Montpellier, France; U1046, Institut National de la Santé et de la Recherche Médicale, Université Montpellier 1, Montpellier, France. Electronic address: elsafaure@hotmail.com. 2. Department of Thoracic and Vascular Surgery, University Hospital, Montpellier, France; U1046, Institut National de la Santé et de la Recherche Médicale, Université Montpellier 1, Montpellier, France. 3. Clinical Research and Epidemiology Department, University Hospital, Montpellier, France. 4. Department of Thoracic and Vascular Surgery, University Hospital, Montpellier, France.
Abstract
OBJECTIVE: This study assessed predictive factors for reintervention after thoracic endovascular aortic repair (TEVAR) for complicated aortic dissection (C-AD). METHODS: An institutional review of consecutive TEVAR for C-AD was performed. RESULTS: Between 2000 and 2011, 41 patients underwent TEVAR for a C-AD involving the descending thoracic aorta. Primary indications included aneurysm >55 mm in 24, rapid aneurysmal enlargement or impending rupture in 6, saccular aneurysm >20 mm in 1, malperfusion in 1, intractable chest pain in 3, and rupture in 6. Technical success was achieved in 100%. The 30-day mortality rate was 5% (n = 2). Fourteen secondary procedures were performed in 13 patients (32%) for indications of device migration in 2, proximal type I endoleak in 5, distal type I endoleak in 2, type II endoleak in 1, aneurysmal evolution of the descending thoracic aorta in 2, aneurysmal expansion of the dissected abdominal aorta in 1, and retrograde dissection in 1. Multivariate analysis demonstrated that oversizing ≥20% (odds ratio [OR], 16; P = .011), bare-spring stent in the proximal landing zone of the stent graft (OR, 12; P = .032), and anticoagulant therapy (OR, 78; P = .03) were significant factors for reintervention. On univariate analysis, large aneurysm was a risk factor for reintervention (P = .002), whereas complete false lumen thrombosis at the stent graft level was protective (P < .05). CONCLUSIONS: This study confirms the feasibility of TEVAR for C-AD, although the rate of reintervention is high. Excessive oversizing, a bare-spring stent graft in the proximal landing zone, large aortic dilatation, and anticoagulant therapy were factors associated with reintervention. Complete false lumen thrombosis at the stent graft level was protective.
OBJECTIVE: This study assessed predictive factors for reintervention after thoracic endovascular aortic repair (TEVAR) for complicated aortic dissection (C-AD). METHODS: An institutional review of consecutive TEVAR for C-AD was performed. RESULTS: Between 2000 and 2011, 41 patients underwent TEVAR for a C-AD involving the descending thoracic aorta. Primary indications included aneurysm >55 mm in 24, rapid aneurysmal enlargement or impending rupture in 6, saccular aneurysm >20 mm in 1, malperfusion in 1, intractable chest pain in 3, and rupture in 6. Technical success was achieved in 100%. The 30-day mortality rate was 5% (n = 2). Fourteen secondary procedures were performed in 13 patients (32%) for indications of device migration in 2, proximal type I endoleak in 5, distal type I endoleak in 2, type II endoleak in 1, aneurysmal evolution of the descending thoracic aorta in 2, aneurysmal expansion of the dissected abdominal aorta in 1, and retrograde dissection in 1. Multivariate analysis demonstrated that oversizing ≥20% (odds ratio [OR], 16; P = .011), bare-spring stent in the proximal landing zone of the stent graft (OR, 12; P = .032), and anticoagulant therapy (OR, 78; P = .03) were significant factors for reintervention. On univariate analysis, large aneurysm was a risk factor for reintervention (P = .002), whereas complete false lumen thrombosis at the stent graft level was protective (P < .05). CONCLUSIONS: This study confirms the feasibility of TEVAR for C-AD, although the rate of reintervention is high. Excessive oversizing, a bare-spring stent graft in the proximal landing zone, large aortic dilatation, and anticoagulant therapy were factors associated with reintervention. Complete false lumen thrombosis at the stent graft level was protective.
Authors: Mohamad Bashir; Matthew Fok; Matthew Shaw; Mark Field; Manoj Kuduvalli; Michael Desmond; Deborah Harrington; Abbas Rashid; Aung Oo Journal: Aorta (Stamford) Date: 2014-06-01
Authors: Joseph S Coselli; Konstantinos Spiliotopoulos; Ourania Preventza; Kim I de la Cruz; Hiruni Amarasekara; Susan Y Green Journal: Gen Thorac Cardiovasc Surg Date: 2016-06-17
Authors: Kristina A Giles; Adam W Beck; Salim Lala; Suzannah Patterson; Martin Back; Javairiah Fatima; Dean J Arnaoutakis; George J Arnaoutakis; Thomas M Beaver; Scott A Berceli; Gilbert R Upchurch; Thomas S Huber; Salvatore T Scali Journal: J Vasc Surg Date: 2018-12-13 Impact factor: 4.268