Intraoperative Stent-Graft-Induced Aortic Intimal Intussusception During TEVAR for Type B Aortic Dissection.

Abstract

BACKGROUND:

Aortic intimal intussusception is well described in the natural progression of type A aortic dissection. Only 3 cases of aortic intimal intussusception were reported to be related to thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection. In our study, we are reporting a rare but potentially fatal complication, the intraoperative stent-graft (SG)-induced aortic intimal intussusception (ISAII); this study reports a series of endovascular repair for ISAII cases. By presenting the ISAII definition, the diagnostic steps to rule out or to identify the condition, and the techniques to resolve it, we intended to raise the awareness of this severe complication, so that physicians can adapt to overcome the complications while performing TEVAR.

MATERIALS AND METHODS:

ISAII was defined as the partial or circumferential disruption of the distal intimal flap as an intraoperative complication of endovascular treatment. From January 2014 to June 2020, 1,096 patients underwent TEVAR for Stanford type B aortic dissection at our hospital. Among them, 14 ISAII complications were witnessed. All these patients underwent endovascular repair for ISAII lesions, and their data were extracted for analysis.

RESULTS:

The ISAII lesions were classified into 3 types according to their location in different aortic segments: type I, ISAII was limited within the intended SG coverage segment; type II, ISAII occurred after SG introduction or deployment, and the detached intimal flap extended beyond the intended SG coverage segment but did not affect the abdominal aortic visceral branches; type III, ISAII occurred during SG introduction or deployment, and the detached intimal flap descended to the abdominal aortic segment with visceral branches. Our results showed ISAII as a rare complication with an incidence of 1.28% (14/1096), and endovascular repair for all types of ISAII is an effective treatment. With a mean follow-up of 27.36 months (range 5-71 months), all the ISAII lesions were stable, and all the major aortic branches, SGs, and bare stents were patent.

CONCLUSIONS:

The management of this potentially devastating intraoperative complication relies on accurate diagnosis and prompt management. Our results suggested that endovascular repair for ISAII is effective and durable for correcting this complication.

GRAPHICAL ABSTRACT:

[Formula: see text].

• Authors: Tao Ma, Fei Liu, Bin Chen, Jun Hao Jiang, Yun Shi, Da Qiao Guo, Xin Xu, Zhi Hui Dong, Wei Guo Fu
• Journal: Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists (J Endovasc Ther) Vol. 28 Issue 6 Pg. 860-870 (Dec 2021) ISSN: 1545-1550 [Electronic] United States
• PMID: 34229510 (Publication Type: Journal Article)

Topics

• Aortic Dissection (diagnostic imaging, surgery)
• Aortic Aneurysm, Thoracic (diagnostic imaging, surgery)
• Blood Vessel Prosthesis
• Blood Vessel Prosthesis Implantation (adverse effects)
• Endovascular Procedures (adverse effects)
• Humans
• Intussusception
• Postoperative Complications (diagnostic imaging, etiology)
• Retrospective Studies
• Stents
• Treatment Outcome