Endovascular Repair of Acute and Chronic Aortic Type B Dissections: Main Factors Affecting Aortic Remodeling and Clinical Outcome

Fabrizio Fanelli; Alessandro Cannavale; Gerard J O'Sullivan; Marianna Gazzetti; Carlo Cirelli; Pierleone Lucatelli; Mariangela Santoni; Carlo Catalano

doi:10.1016/j.jcin.2015.10.027

Endovascular Repair of Acute and Chronic Aortic Type B Dissections: Main Factors Affecting Aortic Remodeling and Clinical Outcome

JACC Cardiovasc Interv. 2016 Jan 25;9(2):183-91. doi: 10.1016/j.jcin.2015.10.027.

Authors

Fabrizio Fanelli¹, Alessandro Cannavale², Gerard J O'Sullivan³, Marianna Gazzetti⁴, Carlo Cirelli², Pierleone Lucatelli², Mariangela Santoni², Carlo Catalano²

Affiliations

¹ Department of Radiological Sciences, University of Rome "Sapienza," Rome, Italy. Electronic address: fabrizio.fanelli@uniroma1.it.
² Department of Radiological Sciences, University of Rome "Sapienza," Rome, Italy.
³ Department of Interventional Radiology, University College Hospital Galway, Galway, Ireland.
⁴ Department of Vascular Surgery, "Sapienza" University of Rome, Rome, Italy.

PMID: 26793960
DOI: 10.1016/j.jcin.2015.10.027

Abstract

Objectives: The aim of this study was to assess factors influencing the clinical outcome and morphological changes of acute and chronic type B aortic dissection after thoracic endovascular aortic repair (TEVAR).

Background: Aortic remodeling after TEVAR may be associated with clinical outcome, complications, and endoleak development.

Methods: Sixty cases of TEVAR for complicated type B acute aortic dissection (AAD) (n = 29) and chronic aortic dissection (CAD) (n = 31) with a minimum follow-up of 3 years were retrospectively reviewed. Using computed tomography images, we assessed true lumen, false lumen, and total aortic short-axis diameters. Six procedural factors were analyzed in relation to aortic remodeling and other outcomes. Analysis of variance was used to compare short-axis, false lumen, and true lumen diameters during the follow-up period. Univariate and multivariate analyses were used to assess the relationship between procedural factors and multiple outcomes.

Results: A total of 100 stent grafts were implanted in 60 consecutive patients with acute aortic dissection (AAD) and CAD. Aortic remodeling consisting of false lumen thrombosis and shrinkage was more prominent in AAD than in CAD, especially within the first 18 months. Of note, the entire aortic diameter increased significantly cephalad to the stent graft in AAD. Only in the AAD group there was increased aortic remodeling related to post-dilation of the stent graft. Type I and II endoleaks occurred in 17 patients (28%); in AAD, embolization of the left subclavian artery after stent graft deployment was significantly associated with a lower risk of endoleak development, but this was not evident in CAD.

Conclusions: Aortic remodeling and clinical outcome after TEVAR can be influenced by procedural techniques (post-dilation and embolization of the left subclavian artery in patients with acute but not chronic aortic dissection).

Keywords: TEVAR; aorta remodeling; aortic dissection; stent graft.

Publication types

Comparative Study
Observational Study

MeSH terms

Acute Disease
Aged
Aorta, Thoracic / pathology
Aorta, Thoracic / physiopathology
Aorta, Thoracic / surgery*
Aortic Aneurysm, Thoracic / diagnosis
Aortic Aneurysm, Thoracic / physiopathology
Aortic Aneurysm, Thoracic / surgery*
Aortic Dissection / diagnosis
Aortic Dissection / physiopathology
Aortic Dissection / surgery*
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / adverse effects
Blood Vessel Prosthesis Implantation* / instrumentation
Chronic Disease
Endoleak / etiology
Endoleak / physiopathology
Endovascular Procedures* / adverse effects
Endovascular Procedures* / instrumentation
Female
Humans
Male
Multivariate Analysis
Retrospective Studies
Risk Factors
Stents
Time Factors
Treatment Outcome
Vascular Remodeling*