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Type A Aortic Dissection After Thoracic Endovascular Aortic Repair.
Ann Thorac Surg 2016; 102(5):1536-1542AT

Abstract

BACKGROUND

Type A aortic dissection (TAAD) is a rare complication associated with thoracic endovascular aortic repair (TEVAR). Although TAAD can result in catastrophic outcomes, the pathology of the condition has not been thoroughly clarified yet.

METHODS

We retrospectively reviewed details from the medical records of 546 patients with diseases of the thoracic aorta (thoracic aortic aneurysm, n = 362; aortic dissection, n = 178; and fistula between the descending thoracic aorta and esophagus, n = 6) who underwent TEVAR in five hospitals from May 1997 through February 2015 to identify patients in whom TAAD developed during or after TEVAR.

RESULTS

TEVAR-associated TAAD developed in 12 patients (2.2%). Pathologies originally treated with TEVAR were aortic dissection in 10 patients (83%) and true thoracic aortic aneurysm in 2 (17%). Type A aortic dissection developed during hospitalization in 4 patients (33%), within 1 year in 5 (42%), and more than 1 year later in 3 (25%). The entry tear was located in the ascending aorta or the aortic arch away from the edges of stent grafts in 8 patients (67%), whereas it was found just at the proximal edges of stent grafts in 4 patients (33%). Nine patients underwent ascending aortic replacement with or without concomitant aortic arch replacement, and 3 patients underwent medical management. Overall, 2 patients (17%) died during hospitalization.

CONCLUSIONS

Type A aortic dissection can develop during TEVAR or even years after TEVAR. Careful operative procedures and follow-up should be mandatory for patients with aortic dissection as TAAD seems to occur more frequently among these patients.

Authors+Show Affiliations

Department of Radiology, Mie University Hospital, Mie, Japan. Electronic address: mar.adriatico0501@gmail.com.Department of Radiology, Mie University Hospital, Mie, Japan.Department of Radiology, Mie University Hospital, Mie, Japan.Department of Radiology, Mie University Hospital, Mie, Japan.Department of Cardiovascular Surgery, Mie University Hospital, Mie, Japan.Department of Cardiovascular Surgery, Ise Red Cross Hospital, Mie, Japan.Department of Cardiovascular Surgery, Anjo Kosei Hospital, Anjo, Aichi, Japan.Department of Cardiovascular Surgery, Mie Central Medical Center, Tsu, Mie, Japan.Department of Cardiovascular Surgery, Kochi Health Sciences Center, Kochi, Japan.Department of Radiology, Mie University Hospital, Mie, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27316317

Citation

Higashigawa, Takatoshi, et al. "Type a Aortic Dissection After Thoracic Endovascular Aortic Repair." The Annals of Thoracic Surgery, vol. 102, no. 5, 2016, pp. 1536-1542.
Higashigawa T, Kato N, Chino S, et al. Type A Aortic Dissection After Thoracic Endovascular Aortic Repair. Ann Thorac Surg. 2016;102(5):1536-1542.
Higashigawa, T., Kato, N., Chino, S., Hashimoto, T., Shimpo, H., Tokui, T., ... Sakuma, H. (2016). Type A Aortic Dissection After Thoracic Endovascular Aortic Repair. The Annals of Thoracic Surgery, 102(5), pp. 1536-1542. doi:10.1016/j.athoracsur.2016.04.024.
Higashigawa T, et al. Type a Aortic Dissection After Thoracic Endovascular Aortic Repair. Ann Thorac Surg. 2016;102(5):1536-1542. PubMed PMID: 27316317.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Type A Aortic Dissection After Thoracic Endovascular Aortic Repair. AU - Higashigawa,Takatoshi, AU - Kato,Noriyuki, AU - Chino,Shuji, AU - Hashimoto,Takashi, AU - Shimpo,Hideto, AU - Tokui,Toshiya, AU - Mizumoto,Toru, AU - Sato,Tomoaki, AU - Okabe,Manabu, AU - Sakuma,Hajime, Y1 - 2016/06/15/ PY - 2015/10/04/received PY - 2016/03/22/revised PY - 2016/04/11/accepted PY - 2016/10/25/pubmed PY - 2017/4/12/medline PY - 2016/6/19/entrez SP - 1536 EP - 1542 JF - The Annals of thoracic surgery JO - Ann. Thorac. Surg. VL - 102 IS - 5 N2 - BACKGROUND: Type A aortic dissection (TAAD) is a rare complication associated with thoracic endovascular aortic repair (TEVAR). Although TAAD can result in catastrophic outcomes, the pathology of the condition has not been thoroughly clarified yet. METHODS: We retrospectively reviewed details from the medical records of 546 patients with diseases of the thoracic aorta (thoracic aortic aneurysm, n = 362; aortic dissection, n = 178; and fistula between the descending thoracic aorta and esophagus, n = 6) who underwent TEVAR in five hospitals from May 1997 through February 2015 to identify patients in whom TAAD developed during or after TEVAR. RESULTS: TEVAR-associated TAAD developed in 12 patients (2.2%). Pathologies originally treated with TEVAR were aortic dissection in 10 patients (83%) and true thoracic aortic aneurysm in 2 (17%). Type A aortic dissection developed during hospitalization in 4 patients (33%), within 1 year in 5 (42%), and more than 1 year later in 3 (25%). The entry tear was located in the ascending aorta or the aortic arch away from the edges of stent grafts in 8 patients (67%), whereas it was found just at the proximal edges of stent grafts in 4 patients (33%). Nine patients underwent ascending aortic replacement with or without concomitant aortic arch replacement, and 3 patients underwent medical management. Overall, 2 patients (17%) died during hospitalization. CONCLUSIONS: Type A aortic dissection can develop during TEVAR or even years after TEVAR. Careful operative procedures and follow-up should be mandatory for patients with aortic dissection as TAAD seems to occur more frequently among these patients. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/27316317/Type_A_Aortic_Dissection_After_Thoracic_Endovascular_Aortic_Repair_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(16)30351-4 DB - PRIME DP - Unbound Medicine ER -