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Thoracic endovascular aortic repair for retrograde type A aortic dissection.
J Vasc Surg 2019; 69(6):1685-1693JV

Abstract

OBJECTIVE

The efficacy of thoracic endovascular aortic repair (TEVAR) for retrograde type A aortic dissection (r-TAAD) with the entry tear in the descending aorta has not been clarified.

METHODS

The medical records of 31 patients who underwent TEVAR for r-TAAD at three institutions between May 1997 and January 2016 were retrospectively reviewed.

RESULTS

The mean age of the patients (30 men and 1 woman) was 64 ± 11 years. The entry tear was located in the descending thoracic aorta in all patients. Seven patients (23%) had dissection-related complications. The false lumen of the ascending aorta was patent in 13 patients (42%) and thrombosed in 18 (58%). The maximum diameter of the ascending aorta was 45 ± 4 mm. TEVAR was performed in the acute phase in 24 patients (77%) and in the subacute phase in 7 (23%). Only one patient (3%) died of aortic rupture within 30 days after TEVAR. Early aorta-related adverse events were observed in eight patients (26%), of whom five underwent additional interventions. The mean follow-up period was 99 ± 69 months. There were no late aorta-related deaths, although five patients died of other causes during follow-up. Overall survival rates at 1 year, 5 years, and 10 years were 97%, 93%, and 80%, respectively. Late aorta-related adverse events were observed in seven patients (23%), of whom five underwent additional interventions. Aorta-related event-free survival rates at 1 year, 5 years, and 10 years were 58%, 58%, and 51%, respectively.

CONCLUSIONS

TEVAR for r-TAAD seems promising in terms of survival. However, the incidence of postoperative aorta-related adverse events is not negligible, so careful selection of patients is important. In addition, close follow-up is mandatory after TEVAR to avoid catastrophic consequences.

Authors+Show Affiliations

Department of Radiology, Mie University Hospital, Tsu, Japan. Electronic address: higashikawat@clin.medic.mie-u.ac.jp.Department of Radiology, Mie University Hospital, Tsu, Japan.Department of Radiology, Mie University Hospital, Tsu, Japan.Department of Radiology, Mie University Hospital, Tsu, Japan.Department of Radiology, Mie University Hospital, Tsu, Japan.Department of Radiology, Mie University Hospital, Tsu, Japan.Department of Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Japan.Department of Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Japan.Department of Cardiovascular Surgery, Anjo Kosei Hospital, Anjo, Japan.Department of Cardiovascular Surgery, Anjo Kosei Hospital, Anjo, Japan.Department of Cardiovascular Surgery, Mie University Hospital, Tsu, Japan.Department of Cardiovascular Surgery, Mie University Hospital, Tsu, Japan.Department of Radiology, Mie University Hospital, Tsu, Japan.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

30612823

Citation

Higashigawa, Takatoshi, et al. "Thoracic Endovascular Aortic Repair for Retrograde Type a Aortic Dissection." Journal of Vascular Surgery, vol. 69, no. 6, 2019, pp. 1685-1693.
Higashigawa T, Kato N, Nakajima K, et al. Thoracic endovascular aortic repair for retrograde type A aortic dissection. J Vasc Surg. 2019;69(6):1685-1693.
Higashigawa, T., Kato, N., Nakajima, K., Chino, S., Hashimoto, T., Ouchi, T., ... Sakuma, H. (2019). Thoracic endovascular aortic repair for retrograde type A aortic dissection. Journal of Vascular Surgery, 69(6), pp. 1685-1693. doi:10.1016/j.jvs.2018.08.193.
Higashigawa T, et al. Thoracic Endovascular Aortic Repair for Retrograde Type a Aortic Dissection. J Vasc Surg. 2019;69(6):1685-1693. PubMed PMID: 30612823.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Thoracic endovascular aortic repair for retrograde type A aortic dissection. AU - Higashigawa,Takatoshi, AU - Kato,Noriyuki, AU - Nakajima,Ken, AU - Chino,Shuji, AU - Hashimoto,Takashi, AU - Ouchi,Takafumi, AU - Tokui,Toshiya, AU - Maze,Yasumi, AU - Mizumoto,Toru, AU - Teranishi,Satoshi, AU - Yamamto,Naoki, AU - Ito,Hisato, AU - Sakuma,Hajime, Y1 - 2019/01/03/ PY - 2018/04/04/received PY - 2018/08/31/accepted PY - 2019/1/8/pubmed PY - 2019/11/19/medline PY - 2019/1/8/entrez KW - Retrograde type A aortic dissection KW - Stent graft KW - TEVAR SP - 1685 EP - 1693 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 69 IS - 6 N2 - OBJECTIVE: The efficacy of thoracic endovascular aortic repair (TEVAR) for retrograde type A aortic dissection (r-TAAD) with the entry tear in the descending aorta has not been clarified. METHODS: The medical records of 31 patients who underwent TEVAR for r-TAAD at three institutions between May 1997 and January 2016 were retrospectively reviewed. RESULTS: The mean age of the patients (30 men and 1 woman) was 64 ± 11 years. The entry tear was located in the descending thoracic aorta in all patients. Seven patients (23%) had dissection-related complications. The false lumen of the ascending aorta was patent in 13 patients (42%) and thrombosed in 18 (58%). The maximum diameter of the ascending aorta was 45 ± 4 mm. TEVAR was performed in the acute phase in 24 patients (77%) and in the subacute phase in 7 (23%). Only one patient (3%) died of aortic rupture within 30 days after TEVAR. Early aorta-related adverse events were observed in eight patients (26%), of whom five underwent additional interventions. The mean follow-up period was 99 ± 69 months. There were no late aorta-related deaths, although five patients died of other causes during follow-up. Overall survival rates at 1 year, 5 years, and 10 years were 97%, 93%, and 80%, respectively. Late aorta-related adverse events were observed in seven patients (23%), of whom five underwent additional interventions. Aorta-related event-free survival rates at 1 year, 5 years, and 10 years were 58%, 58%, and 51%, respectively. CONCLUSIONS: TEVAR for r-TAAD seems promising in terms of survival. However, the incidence of postoperative aorta-related adverse events is not negligible, so careful selection of patients is important. In addition, close follow-up is mandatory after TEVAR to avoid catastrophic consequences. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/30612823/Thoracic_endovascular_aortic_repair_for_retrograde_type_A_aortic_dissection_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(18)32269-9 DB - PRIME DP - Unbound Medicine ER -