Risk Factors of Early and Late Mortality After Thoracic Endovascular Aortic Repair for Complicated Stanford B Acute Aortic Dissection

2014 ◽  
Vol 29 (4) ◽  
pp. 501-506 ◽  
Author(s):  
Zhong-Bao Ruan ◽  
Li Zhu ◽  
Yi-Gang Yin ◽  
Ge-Cai Chen
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Late Mortality ◽  
Aortic Repair ◽  
Stanford B

Unplanned stents in thoracic endovascular aortic repair for type B aortic dissection: A 16-year single-center report

Vascular ◽  
2017 ◽  
Vol 26 (4) ◽  
pp. 400-409
Author(s):  
Junjun Liu ◽  
Rongjie Zhang ◽  
Rui Feng ◽  
Jiaxuan Feng ◽  
Zhiqing Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Operation Time ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Rank Test ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Aortic Repair ◽  
Type Ia

Background Unplanned stents in thoracic endovascular aortic repair mean additional stents implantation beyond the preoperative planning to achieve operation success. This study aimed to reveal the prevalence and consequences of unplanned stents in thoracic endovascular aortic repair for type B aortic dissection and explore the reasons, risk factors and solutions for unplanned stents. Methods Retrospectively analysis consecutive patients diagnosed as type B aortic dissection with initial tear originating distal from the left subclavian artery and underwent thoracic endovascular aortic repair from September 1998 to June 2014 in our center. Results Under the criteria, this study enrolled 322 patients, with 83 (25.8%) patients in unplanned group. The incidence rate of unplanned stents in thoracic endovascular aortic repair for type B aortic dissection in each year demonstrates as a bimodal curve. The curve showed that, 2003 and, 2004 was the first and highest peak and 2007 was the second peak. There was no difference in five-year survival rate between planned and unplanned patients (log-rank test, p = 0.994). The unplanned group had higher hospitalization expenses (142,699.08 ± 78,446.75 yuan vs. 175,238.58 ± 34,838.01 yuan; p = 0.019), longer operation time (104.50 ± 93.24 min vs. 179.08 ± 142.47 min; p < 0.001) and hospitalization time (17.07 ± 16.62 d vs. 24.00 ± 15.34 d; p = 0.001). The reasons for unplanned stents were type Ia endoleak (46 patients, 55.4%), bird beak (25 patients, 30.1%), and inappropriate shaping of stent (9 patients, 10.8%). Asymptomatic aortic dissection patients had higher incidence of unplanned stents. Short proximal neck length (2.66 ± 0.59 mm vs. 2.50 ± 0.51 mm; p = 0.016), short stent coverage length (154.62 ± 41.12 mm vs. 133.60 ± 44.33 mm; p = 0.002), and large distal stent oversize (75.44±10.77% vs. 82.68±15.80%; p <0.001) were risk factors for unplanned stents in thoracic endovascular aortic repair. Conclusion There are some special risk factors and reasons for unplanned stents in thoracic endovascular aortic repair for type B aortic dissection. Knowing these can we reduce the utilization of unplanned stents with appropriate methods.

Abstract 19354: Management and Outcomes of Acute Type B Dissection in IRAD Treated with Open Surgery, Endovascular Flap Fenestration or TEVAR

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Nathaniel I Costin ◽  
Peter Levanovich ◽  
Eduardo Bossone ◽  
Mark D Peterson ◽  
Truls Myrmel ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Open Surgery ◽  
Acute Aortic Dissection ◽  
Open Repair ◽  
Surgical Intervention ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Acute Type ◽  
Type B ◽  
Aortic Repair

Background: The debate for the optimal treatment of complicated Type B Acute Aortic Dissection (TBAAD) is primarily focused upon open surgical intervention versus thoracic endovascular aortic repair (TEVAR). The technique of fenestration with stenting has been proposed to resolve malperfusion. This study evaluated post-procedural outcomes of all three approaches for TBAAD. Methods: TBAAD patients enrolled in the International Registry of Acute Aortic Dissection were stratified by management type: TEVAR, fenestration and stenting, and surgery. Results: Of the 552 patients with TBAAD, 231 (41.8%) underwent TEVAR, 214 (38.8%) standard open surgery, and 107 (19.4%) fenestration and stenting. TEVAR or fenestration and stenting were more likely to be performed in classic double barrel aortic dissection when compared to open surgery (73.2%, 76.6%, 52.8% respectively; p<0.001). Patients treated with open repair were less likely to have distal extension into the abdominal aorta than those with TEVAR or fenestration and stenting (47.7%, 62.7%, 86.4%, respectively; p<0.001). In-hospital mortality was similar between groups (11.7% TEVAR, 14.0% fenestration and stenting, 15.9% surgery). At five years, Kaplan-Meier post-discharge all-cause survival estimates were highest for TEVAR, followed by endovascular fenestration and finally open surgical intervention (85.2%, 78.3%, 67.2%, respectively; p=0.039). Conclusion: Patients treated by endovascular approaches, whether with flap fenestration or thoracic endovascular aortic repair, had lower five year mortality when compared to patients who required open repair in the setting of TBAAD. Either endovascular approach may be helpful in the treatment of TBAAD. Further research is needed to determine how much of the observed difference represents patient selection versus differential effects of treatment.

scholarly journals Risk factors for early and late mortality after thoracic endovascular aortic repair

2008 ◽  
Vol 135 (5) ◽  
pp. 1103-1109.e4 ◽  
Author(s):  
Ali Khoynezhad ◽  
Carlos E. Donayre ◽  
Jennifer Smith ◽  
George E. Kopchok ◽  
Irwin Walot ◽  
...  
Keyword(s):  
Risk Factors ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Late Mortality ◽  
Aortic Repair

scholarly journals Application of thoracic endovascular aortic repair (TEVAR) in treating dwarfism with Stanford B aortic dissection

Medicine ◽  
2018 ◽  
Vol 97 (17) ◽  
pp. e0542
Author(s):  
Jian Qiu ◽  
Wenwu Cai ◽  
Chang Shu ◽  
Ming Li ◽  
Qinggen Xiong ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair ◽  
Stanford B
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