Thoracic endovascular aortic repair for the treatment of ruptured acute type B aortic dissection.

Abstract

PURPOSE:

To evaluate the efficacy of thoracic endovascular aortic repair (TEVAR) for ruptured acute type B aortic dissection (r-ATBAD).

MATERIALS AND METHODS:

The study included 18 patients (15 men and 3 women) who underwent TEVAR for r-ATBAD in two institutions between 1997 and 2017. The mean patient age was 74 ± 10 years. The false lumen was patent in 13 patients (72%) and was mostly thrombosed in 5 patients (28%). Three patients had malperfusion of aortic branches. Eight patients (44%) were in circulatory shock.

RESULTS:

Eleven patients (61%) died during or following TEVAR during admission. The causes of death were aortic rupture (n = 6), sepsis (n = 2), cerebral hypoxia (n = 1), pneumonia (n = 1), and renal failure (n = 1). Statistical analysis showed that dissection extending to the infrarenal level was significantly related to death from aortic rupture (P = 0.013). Early adverse events were observed in 12 patients (67%). One patient died from a non-aorta-related cause (sepsis) after discharge. The overall survival rate at 1 year was 39%. After discharge, an aorta-related adverse event (intimal injury) was observed in one patient. The adverse event-free survival rate at 1 year was 17%.

CONCLUSIONS:

Our results indicate that TEVAR for r-ATBAD is associated with high mortality and morbidity. More advanced strategies may be required to improve the outcome.

• Authors: Shuji Chino, Noriyuki Kato, Ken Nakajima, Takashi Hashimoto, Takatoshi Higashigawa, Takafumi Ouchi, Hiroaki Kato, Naoki Yamamoto, Hisato Ito, Yasumi Maze, Toshiya Tokui, Hajime Sakuma
• Journal: Japanese journal of radiology (Jpn J Radiol) Vol. 37 Issue 4 Pg. 321-327 (Apr 2019) ISSN: 1867-108X [Electronic] Japan
• PMID: 30712166 (Publication Type: Journal Article)

Chemical References

• Contrast Media

Topics

• Aged
• Aged, 80 and over
• Aortic Dissection (diagnostic imaging, surgery)
• Aorta, Thoracic (diagnostic imaging, surgery)
• Aortic Aneurysm, Thoracic (diagnostic imaging, surgery)
• Aortic Rupture (diagnostic imaging, surgery)
• Contrast Media
• Endovascular Procedures (methods, mortality)
• Female
• Humans
• Kaplan-Meier Estimate
• Male
• Radiographic Image Enhancement (methods)
• Retrospective Studies
• Survival Rate
• Time Factors
• Tomography, X-Ray Computed (methods)
• Treatment Outcome