Thoracic endovascular aortic repair for retrograde type A aortic dissection.

Abstract

OBJECTIVE:

The efficacy of thoracic endovascular aortic repair (TEVAR) for retrograde type A aortic dissection (r-TAAD) with the entry tear in the descending aorta has not been clarified.

METHODS:

The medical records of 31 patients who underwent TEVAR for r-TAAD at three institutions between May 1997 and January 2016 were retrospectively reviewed.

RESULTS:

The mean age of the patients (30 men and 1 woman) was 64 ± 11 years. The entry tear was located in the descending thoracic aorta in all patients. Seven patients (23%) had dissection-related complications. The false lumen of the ascending aorta was patent in 13 patients (42%) and thrombosed in 18 (58%). The maximum diameter of the ascending aorta was 45 ± 4 mm. TEVAR was performed in the acute phase in 24 patients (77%) and in the subacute phase in 7 (23%). Only one patient (3%) died of aortic rupture within 30 days after TEVAR. Early aorta-related adverse events were observed in eight patients (26%), of whom five underwent additional interventions. The mean follow-up period was 99 ± 69 months. There were no late aorta-related deaths, although five patients died of other causes during follow-up. Overall survival rates at 1 year, 5 years, and 10 years were 97%, 93%, and 80%, respectively. Late aorta-related adverse events were observed in seven patients (23%), of whom five underwent additional interventions. Aorta-related event-free survival rates at 1 year, 5 years, and 10 years were 58%, 58%, and 51%, respectively.

CONCLUSIONS:

TEVAR for r-TAAD seems promising in terms of survival. However, the incidence of postoperative aorta-related adverse events is not negligible, so careful selection of patients is important. In addition, close follow-up is mandatory after TEVAR to avoid catastrophic consequences.

• Authors: Takatoshi Higashigawa, Noriyuki Kato, Ken Nakajima, Shuji Chino, Takashi Hashimoto, Takafumi Ouchi, Toshiya Tokui, Yasumi Maze, Toru Mizumoto, Satoshi Teranishi, Naoki Yamamto, Hisato Ito, Hajime Sakuma
• Journal: Journal of vascular surgery (J Vasc Surg) Vol. 69 Issue 6 Pg. 1685-1693 (Jun 2019) ISSN: 1097-6809 [Electronic] United States
• PMID: 30612823 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Aortic Dissection (diagnostic imaging, mortality, surgery)
• Aortic Aneurysm, Thoracic (diagnostic imaging, mortality, surgery)
• Blood Vessel Prosthesis
• Blood Vessel Prosthesis Implantation (adverse effects, instrumentation, mortality)
• Endovascular Procedures (adverse effects, instrumentation, mortality)
• Female
• Humans
• Japan
• Male
• Middle Aged
• Postoperative Complications (mortality, surgery)
• Progression-Free Survival
• Reoperation
• Retrospective Studies
• Risk Factors
• Stents
• Time Factors