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Endovascular repair of residual intimal tear or distal new entry after frozen elephant trunk for type A aortic dissection.
J Thorac Dis 2017; 9(3):529-536JT

Abstract

BACKGROUND

In patients with type A dissection, residual dissection and new distal entry tears following the frozen elephant trunk (FET) procedure adversely affect long-term prognosis. Management include open and endovascular repair, while clinical experience is limited. We evaluate the efficacy of thoracic endovascular aortic repair (TEVAR) in management of residual intimal tear or distal new entry tear following FET in patients with type A aortic dissection (TAAD).

METHODS

Between May 2003 and April 2013, we performed FET and total arch replacement for 1,003 patients with TAAD. Among these, 23 patients (2.3%) required TEVAR for distal new entry (n=2) or residual intimal tear (n=21) at a mean of 2.0±1.6 years after FET. Mean age was 50.1±11.5 years. Marfan syndrome was seen in 2 patients (8.7%).

RESULTS

Procedural success was 100%. The distal landing zone was above the 11th thoracic vertebra (T11) in 86.9% (20/23). Neither death nor any paraplegia or stroke occurred early after TEVAR. Follow-up was complete in 100% averaging 2.8±1.7 years (0.3-6.4). One non-Marfan patient died of distal aortic rupture at 4 months after TEVAR. No late stroke or paraplegia occurred. Survival was 95.7% (95% CI, 72.9-99.4%) at 3 and 5 years, respectively. CTA detected false lumen obliteration by thrombus around the endograft in the descending aorta in 91.3% (21/23) of patients.

CONCLUSIONS

These early and midterm outcomes show the efficacy of TEVAR in obliterating the residual intimal tear or distal new entry after FET in patients with TAAD. TEVAR may be an alternative approach to distal new entry or residual intimal tear following FET for patients with TAAD.

Authors+Show Affiliations

Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Aortic Disease Center, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China.Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Aortic Disease Center, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China.Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Aortic Disease Center, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China.Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Aortic Disease Center, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China.Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Aortic Disease Center, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China.Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Aortic Disease Center, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China.Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Aortic Disease Center, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China.Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Aortic Disease Center, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28449459

Citation

Pan, Xu-Dong, et al. "Endovascular Repair of Residual Intimal Tear or Distal New Entry After Frozen Elephant Trunk for Type a Aortic Dissection." Journal of Thoracic Disease, vol. 9, no. 3, 2017, pp. 529-536.
Pan XD, Li B, Ma WG, et al. Endovascular repair of residual intimal tear or distal new entry after frozen elephant trunk for type A aortic dissection. J Thorac Dis. 2017;9(3):529-536.
Pan, X. D., Li, B., Ma, W. G., Zheng, J., Liu, Y. M., Zhu, J. M., ... Sun, L. Z. (2017). Endovascular repair of residual intimal tear or distal new entry after frozen elephant trunk for type A aortic dissection. Journal of Thoracic Disease, 9(3), pp. 529-536. doi:10.21037/jtd.2017.03.04.
Pan XD, et al. Endovascular Repair of Residual Intimal Tear or Distal New Entry After Frozen Elephant Trunk for Type a Aortic Dissection. J Thorac Dis. 2017;9(3):529-536. PubMed PMID: 28449459.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endovascular repair of residual intimal tear or distal new entry after frozen elephant trunk for type A aortic dissection. AU - Pan,Xu-Dong, AU - Li,Bin, AU - Ma,Wei-Guo, AU - Zheng,Jun, AU - Liu,Yong-Min, AU - Zhu,Jun-Ming, AU - Huang,Lian-Jun, AU - Sun,Li-Zhong, PY - 2017/4/29/entrez PY - 2017/4/30/pubmed PY - 2017/4/30/medline KW - Thoracic endovascular aortic repair (TEVAR) KW - aortic arch replacement KW - frozen elephant trunk (FET) KW - type A aortic dissection (TAAD) SP - 529 EP - 536 JF - Journal of thoracic disease JO - J Thorac Dis VL - 9 IS - 3 N2 - BACKGROUND: In patients with type A dissection, residual dissection and new distal entry tears following the frozen elephant trunk (FET) procedure adversely affect long-term prognosis. Management include open and endovascular repair, while clinical experience is limited. We evaluate the efficacy of thoracic endovascular aortic repair (TEVAR) in management of residual intimal tear or distal new entry tear following FET in patients with type A aortic dissection (TAAD). METHODS: Between May 2003 and April 2013, we performed FET and total arch replacement for 1,003 patients with TAAD. Among these, 23 patients (2.3%) required TEVAR for distal new entry (n=2) or residual intimal tear (n=21) at a mean of 2.0±1.6 years after FET. Mean age was 50.1±11.5 years. Marfan syndrome was seen in 2 patients (8.7%). RESULTS: Procedural success was 100%. The distal landing zone was above the 11th thoracic vertebra (T11) in 86.9% (20/23). Neither death nor any paraplegia or stroke occurred early after TEVAR. Follow-up was complete in 100% averaging 2.8±1.7 years (0.3-6.4). One non-Marfan patient died of distal aortic rupture at 4 months after TEVAR. No late stroke or paraplegia occurred. Survival was 95.7% (95% CI, 72.9-99.4%) at 3 and 5 years, respectively. CTA detected false lumen obliteration by thrombus around the endograft in the descending aorta in 91.3% (21/23) of patients. CONCLUSIONS: These early and midterm outcomes show the efficacy of TEVAR in obliterating the residual intimal tear or distal new entry after FET in patients with TAAD. TEVAR may be an alternative approach to distal new entry or residual intimal tear following FET for patients with TAAD. SN - 2072-1439 UR - https://www.unboundmedicine.com/medline/citation/28449459/Endovascular_repair_of_residual_intimal_tear_or_distal_new_entry_after_frozen_elephant_trunk_for_type_A_aortic_dissection_ L2 - https://doi.org/10.21037/jtd.2017.03.04 DB - PRIME DP - Unbound Medicine ER -