Flow density of computed tomography aortography for predicting early unfavorable aortic remodeling after TEVAR in type IIIb aortic dissection

Hung-Lung Hsu; Yun-Ning Chiu; Tai-Wei Chen; Chun-Yang Huang; Chun-Che Shih; Chiao-Po Hsu

doi:10.1016/j.ijcard.2021.04.010

Flow density of computed tomography aortography for predicting early unfavorable aortic remodeling after TEVAR in type IIIb aortic dissection

Int J Cardiol. 2021 Jun 1:332:41-47. doi: 10.1016/j.ijcard.2021.04.010. Epub 2021 Apr 5.

Authors

Hung-Lung Hsu¹, Yun-Ning Chiu², Tai-Wei Chen³, Chun-Yang Huang³, Chun-Che Shih², Chiao-Po Hsu⁴

Affiliations

¹ School of Medicine, National Yang Ming University, Taipei, Taiwan; National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Cardiovascular Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
² School of Medicine, National Yang Ming University, Taipei, Taiwan; National Yang Ming Chiao Tung University, Taipei, Taiwan.
³ School of Medicine, National Yang Ming University, Taipei, Taiwan; National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
⁴ School of Medicine, National Yang Ming University, Taipei, Taiwan; National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address: chiaopo@ms39.hinet.net.

PMID: 33831506
DOI: 10.1016/j.ijcard.2021.04.010

Abstract

Objective: Patients diagnosed of DeBakey type III aortic dissection with partial thrombosis of false lumen (FL) have a higher mortality rate. However, IIIb dissections with full patent FL tend to exhibit a partially thrombosed FL quickly after thoracic endovascular aortic repair (TEVAR); thus, we investigated survival and aortic remodeling in this population.

Methods: We reviewed computed tomography aortograms (CTAs) of 123 patients with TEVAR-treated IIIb aortic dissections from July 2006 to June 2015; contrast density of CTAs represented intraluminal flow. Patients were selected to fit in 2 groups of FL in term of FL contrast density: low flow (LF) group (non-opacification in the midway of FL) and high flow (HF) group (full patent FL).

Results: Surgical mortality was 10.3% in the HF group and 4.5% in the LF group (n = 61; LF = 22; HF = 39). 3 patients in the HF group suffered from lethal aortic rupture in 10 days postoperatively. The HF group showed significant increase in maximal diameter, and had larger thoracic (+4.00 ± 2.68 vs -1.16 ± 3.42 mm, P < .001) aortic diameter expansion from preoperation to one week postoperation. Both groups exhibited significant favorable thoracic TL expansion and maximal aortic diameter shrinkage in postoperative one week to one year. However, HF group displayed less thoracic aortic FL regression (-70.9 ± 83.5 vs -113.9 ± 95.0 cm³, P = .1) and TL expansion (+14.5 ± 27.2 vs +36.8 ± 28.3 cm³, P = .008) when compared to LF group.

Conclusions: Preoperative HF in the FL has an unfavorable effect on thoracic aortic diameter in one week post-TEVAR. This might increase the risk of aortic rupture.

Keywords: Computed tomography aortography; Contrast density; False lumen; Stent graft; TEVAR; Type IIIb aortic dissection.

MeSH terms

Aortic Aneurysm, Thoracic* / diagnostic imaging
Aortic Aneurysm, Thoracic* / surgery
Aortic Dissection* / diagnostic imaging
Aortic Dissection* / surgery
Aortography
Blood Vessel Prosthesis Implantation*
Endovascular Procedures*
Humans
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Vascular Remodeling