Tae-Hoon Kim1, Suk-Won Song2, Kwang-Hun Lee3, Min-Young Baek1, Kyung-Jong Yoo4, Bum-Koo Cho5. 1. Department of Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. 2. Department of Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: sevraphd@yuhs.ac. 3. Department of Interventional Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. 4. Department of Cardiovascular Surgery, Yonsei Cardiovascular Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. 5. Korea Heart Foundation, Seoul, Republic of Korea.
Abstract
OBJECTIVE: Although thoracic endovascular aortic repair (TEVAR) is commonly used for chronic DeBakey type IIIB (CDIIIB) dissections, aortic remodeling outcomes after the procedure have been unsatisfactory. Persistent retrograde flow to the false lumen (FL) through re-entry tears commonly causes treatment failure. The aim of this study was to clarify the safety and effect of the FL procedure (FLP) for aortic remodeling in patients with CDIIIB dissections. METHODS: From 2012 to 2016, there were 73 patients who underwent TEVAR for CDIIIB dissections. The surgery, accompanied by the FLP, was performed in 41 patients (group A, 56%); 32 patients (group B, 44%) underwent TEVAR alone. The FLP was defined as blocking the retrograde FL flow with commercial materials. Outcomes included whole thoracic aorta FL thrombosis and diameter change in the true lumen and FL. Diameters were measured at three levels (left subclavian artery, pulmonary artery bifurcation, and celiac axis). RESULTS: No in-hospital mortality was observed. There was one case each of paraplegia and stroke postoperatively. The whole thoracic aorta FL thrombosis rate was significantly higher in group A (83% vs 56%; P = .002). Significant aortic remodeling (true lumen expansion and FL regression) was observed in both groups. In multivariable Cox regression analysis, the FLP and the number of re-entries were independent predictors for thoracic FL thrombosis (hazard ratio, 2.339 [P = .009] and 0.709 [P < .001], respectively). CONCLUSIONS: Full-coverage TEVAR with the FLP seems to be a safe endovascular treatment and promotes thoracic FL thrombosis for patients with CDIIIB dissections.
OBJECTIVE: Although thoracic endovascular aortic repair (TEVAR) is commonly used for chronic DeBakey type IIIB (CDIIIB) dissections, aortic remodeling outcomes after the procedure have been unsatisfactory. Persistent retrograde flow to the false lumen (FL) through re-entry tears commonly causes treatment failure. The aim of this study was to clarify the safety and effect of the FL procedure (FLP) for aortic remodeling in patients with CDIIIB dissections. METHODS: From 2012 to 2016, there were 73 patients who underwent TEVAR for CDIIIB dissections. The surgery, accompanied by the FLP, was performed in 41 patients (group A, 56%); 32 patients (group B, 44%) underwent TEVAR alone. The FLP was defined as blocking the retrograde FL flow with commercial materials. Outcomes included whole thoracic aorta FLthrombosis and diameter change in the true lumen and FL. Diameters were measured at three levels (left subclavian artery, pulmonary artery bifurcation, and celiac axis). RESULTS: No in-hospital mortality was observed. There was one case each of paraplegia and stroke postoperatively. The whole thoracic aorta FLthrombosis rate was significantly higher in group A (83% vs 56%; P = .002). Significant aortic remodeling (true lumen expansion and FL regression) was observed in both groups. In multivariable Cox regression analysis, the FLP and the number of re-entries were independent predictors for thoracic FL thrombosis (hazard ratio, 2.339 [P = .009] and 0.709 [P < .001], respectively). CONCLUSIONS: Full-coverage TEVAR with the FLP seems to be a safe endovascular treatment and promotes thoracic FL thrombosis for patients with CDIIIB dissections.