scholarly journals Number and Location of Abdominal Aorta Entry Tear is Associated with Abdominal Aorta Remodeling After Stent Grafting for Complicated Type B Aortic Dissection

2014 ◽  
Vol 48 (3) ◽  
pp. 338
Author(s):  
I.-M. Chen ◽  
C.-C. Shih
Keyword(s):  
Aortic Dissection ◽  
Abdominal Aorta ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Stent Grafting

Complications after Endovascular Repair of Type B Aortic Dissection

2002 ◽  
Vol 9 (6) ◽  
pp. 822-828 ◽  
Author(s):  
Reinhard S. Pamler ◽  
Thomas Kotsis ◽  
Johannes Görich ◽  
Xaver Kapfer ◽  
Karl-Heinz Orend ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Stent Grafting ◽  
Stent Graft Implantation ◽  
Graft Implantation

Purpose: To outline the complications encountered after endoluminal treatment in patients with type B aortic dissection. Methods: Between 1999 and 2001, 14 patients (12 men; mean age 60.3 years, range 39–79) with isolated type B aortic dissection (13 chronic, 1 acute) underwent aortic stent-grafting. Three patients with chronic dissection presented an acute clinical picture and were managed emergently. The left subclavian artery was intentionally covered by the prosthesis in 9 patients. Follow-up studies were performed at 6-month intervals. Results: Stent-graft implantation was technically successful in all patients, but incomplete sealing (endoleak) of the entry site required additional proximal stent-graft implantation in 4. The left subclavian artery remained patent in 5 patients. Secondary conversion was required in 3 patients: 2 for acute type A dissection resulting from injury to the aortic arch by Talent endografts and a sustained hemorrhage (left hemothorax). In another patient, a secondary intramural hematoma subsided spontaneously. Anterior spinal artery syndrome in 1 patient persisted at 1 month. No bypass was necessary for the 9 patients with the covered left subclavian arteries. Mean follow-up was 14 months (range 1–23). Conclusions: Stent-grafting is feasible in patients with type B aortic dissection, although it is associated with a considerable rate of complications. Frank reporting of these sequelae for a variety of stent-grafts is of paramount importance to clarifying the limitations of the method.

Persistent Type B Aortic Dissection Treatment by Renal Artery Reentry Stent Grafting as an Alternative to Open Surgery

2013 ◽  
Vol 27 (4) ◽  
pp. 498.e5-498.e8 ◽  
Author(s):  
Ludovic Berger ◽  
Laura Palcau ◽  
Djelloul Gouicem ◽  
Olivier Coffin
Keyword(s):  
Aortic Dissection ◽  
Renal Artery ◽  
Open Surgery ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Stent Grafting

scholarly journals Management of Uncomplicated Type B Aortic Dissection

Hearts ◽  
2020 ◽  
Vol 1 (1) ◽  
pp. 14-24
Author(s):  
Xun Yuan ◽  
Rachel E. Clough ◽  
Christoph A. Nienaber
Keyword(s):  
Aortic Dissection ◽  
Endovascular Repair ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Term Survival ◽  
Subacute Phase ◽  
Stent Grafting ◽  
Best Medical Treatment ◽  
Type B Dissection ◽  
Acute Dissection

Acute aortic dissection has an incidence of approximately half that of symptomatic abdominal and thoracic aneurysm of the aorta and more than twice the mortality of population-based controls. While urgent undelayed open surgery is the strategy of choice in proximal dissection, medical management has been the mainstay of treatment for uncomplicated distal or type B aortic dissection, but endovascular intervention is now considered a potential treatment option for all type B dissection due to its success in complicated cases. Endovascular repair can be technically demanding in aortic dissection, and timing of the repair can have a significant influence on anatomical and clinical outcome. Observational reports of feasibility and reasonable safety are flanked by only two randomised trials; the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) trial demonstrated improved remodelling in acute dissection and the INvestigation of STEnt grafts in patients with type B Aortic Dissections (INSTEAD) trial showed better long-term survival in patients treated endovascularly in the subacute phase. Meta-analyses and other large clinical studies have demonstrated mixed results. Due to some risks associated endovascular repair and the requirement of specialist aortic care (which is not always available), a pragmatic approach for current management could involve high intensity serial imaging in the acute phase of a type B aortic dissection, thereby identifying complicated cases for early intervention and selection of patients at high risk of disease progression for deferred endovascular management in the subacute phase within 90 days.

Dissection length-to-descending thoraco-abdominal aorta length ratio predicts abdominal aortic enlargement after thoracic endovascular aortic repair for type B aortic dissection involving the abdominal aorta

2020 ◽  
Vol 31 (5) ◽  
pp. 680-687
Author(s):  
Xinhao Wang ◽  
Yangyang Ge ◽  
Xiaohu Ge ◽  
Jianhang Miao ◽  
Weidong Fan ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Abdominal Aorta ◽  
Cumulative Incidence ◽  
Inflection Point ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Nonlinear Relationship ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Abdominal Aortic

Abstract OBJECTIVES This study was performed to assess the association between the dissection length-to-descending thoraco-abdominal aorta length ratio (LLR) and abdominal aortic enlargement (AAE) (≥20% increase in total abdominal aortic volume) after thoracic endovascular aortic repair (TEVAR) in patients with type B aortic dissection. METHODS We retrospectively analysed data from 184 consecutive patients with type B aortic dissection who underwent TEVAR from January 2011 to December 2016 at 4 hospitals as part of the Registry Of type B aortic dissection with Utility of STent graft study. Preoperative and postoperative computed tomography angiography images were reviewed to assess the LLR and AAE. Patients were stratified into tertiles according to the pre-TEVAR LLR: 0.7 to <1.0 (n = 61), 1.0 to <1.2 (n = 61) and 1.2 to <1.6 (n = 62). The thoracic and abdominal aorta were divided by the celiac trunk. The cumulative incidence of AAE was estimated using the Kaplan–Meier method. A multivariable Cox proportional hazards model was used to assess the independent association between the preoperative LLR and the post-TEVAR risk of AAE. The nonlinear relationship between the LLR and the risk of post-TEVAR AAE was fitted by the restricted cubic smoothing spline, and the inflection point on the fitting curve was determined using a piecewise linear regression model. RESULTS Baseline demographics, clinical features, preoperative anatomic characteristics and implanted devices were similarly distributed among the pre-TEVAR LLR tertile groups. At 24 months post-TEVAR, the estimated cumulative incidence of AAE significantly differed (P < 0.01) by LLR tertile group: 0.10 [95% confidence interval (CI) 0.00–0.21], 0.65 (95% CI 0.45–0.78) and 0.67 (95% CI 0.40–0.82), respectively. The pre-TEVAR LLR was an independent predictor of post-TEVAR AAE [hazard ratio (per unit increase) 1.03, 95% CI 1.01–1.04] following a nonlinear relationship with an inflection point at LLR = 1.0. CONCLUSIONS The risk of post-TEVAR AAE is highest when the length of the dissection is greater than or equal to the length of the descending aorta (LLR ≥ 1.0).

Emergency stent grafting of type B aortic dissection: technical considerations

2008 ◽  
Vol 15 (6) ◽  
pp. 375-382 ◽  
Author(s):  
Tommaso Lupattelli ◽  
Francesco Giuseppe Garaci ◽  
Antonio Basile ◽  
Andrea Casini ◽  
Ilias Dalainas ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Stent Grafting ◽  
Technical Considerations

scholarly journals Predictors of aortic growth in uncomplicated type B aortic dissection from the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) database

2017 ◽  
Vol 65 (4) ◽  
pp. 964-971.e3 ◽  
Author(s):  
Arnoud V. Kamman ◽  
Jan Brunkwall ◽  
Eric L. Verhoeven ◽  
Robin H. Heijmen ◽  
Santi Trimarchi ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Medical Treatment ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Stent Grafting ◽  
Best Medical Treatment ◽  
Acute Dissection

scholarly journals Complicated acute type B aortic dissection: Midterm results of emergency endovascular stent–grafting

2008 ◽  
Vol 136 (2) ◽  
pp. 424-430 ◽  
Author(s):  
Jean Phillipe Verhoye ◽  
D. Craig Miller ◽  
Daniel Sze ◽  
Michael D. Dake ◽  
R. Scott Mitchell
Keyword(s):  
Aortic Dissection ◽  
Acute Type ◽  
Endovascular Stent ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Midterm Results ◽  
Stent Grafting ◽  
Endovascular Stent Grafting
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