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Thoracic Endovascular Aortic Repair for Type A Intramural Hematoma and Retrograde Thrombosed Type A Aortic Dissection: A Single Center Experience.

Abstract

OBJECTIVE

The aim of this study was to present our experience of thoracic endovascular aortic repair (TEVAR) for type A intramural hematoma (TAIMH) and retrograde thrombosed type A aortic dissection (rt-TAAD) with the entry tear in the descending aorta or the abdominal aorta and discuss the outcomes.

MATERIAL AND METHODS

We retrospective reviewed total 6 patients who underwent TEVAR for TAIMH (n = 2) or rt-TAAD (n = 4) in our hospital between September 2017 and July 2019. The mean age of the patients (5 men and 1 woman) was 74 ± 13 years, and the mean follow-up duration was 13 ± 7 months.

RESULTS

TEVAR was successfully performed in the acute phase in all patients without relevant complications. After TEVAR, the shrinkage of enlarged thoracic aorta and complete resorptions of the false lumen of the entire thoracic aorta were achieved in 4 patients. In the remaining 2 patients, one had residual thrombosed false lumen of the ascending aorta due to a new development of PAU at the distal aortic arch and another need additional endovascular intervention for ascending aorta hematoma progression. Late aorta-related adverse event was observed in 1 patient, who needed open aortic repair. There was no death during follow-up.

CONCLUSIONS

Tear-oriented endovascular aortic repair is a potential option in selected patients of TAIMH and rt-TAAD and has shown favorable immediate outcomes and aortic remodeling. However, the late aorta-related adverse event is not negligible, and their long-term outcome has not been fully clarified. More research is warranted.

Authors+Show Affiliations

Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. Electronic address: yenyu1983@cgmh.org.tw.Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31743779

Citation

Chen, Yen-Yu, et al. "Thoracic Endovascular Aortic Repair for Type a Intramural Hematoma and Retrograde Thrombosed Type a Aortic Dissection: a Single Center Experience." Annals of Vascular Surgery, 2019.
Chen YY, Yen HT, Wu CC, et al. Thoracic Endovascular Aortic Repair for Type A Intramural Hematoma and Retrograde Thrombosed Type A Aortic Dissection: A Single Center Experience. Ann Vasc Surg. 2019.
Chen, Y. Y., Yen, H. T., Wu, C. C., & Kwan-Ru Huang, D. (2019). Thoracic Endovascular Aortic Repair for Type A Intramural Hematoma and Retrograde Thrombosed Type A Aortic Dissection: A Single Center Experience. Annals of Vascular Surgery, doi:10.1016/j.avsg.2019.11.016.
Chen YY, et al. Thoracic Endovascular Aortic Repair for Type a Intramural Hematoma and Retrograde Thrombosed Type a Aortic Dissection: a Single Center Experience. Ann Vasc Surg. 2019 Nov 16; PubMed PMID: 31743779.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Thoracic Endovascular Aortic Repair for Type A Intramural Hematoma and Retrograde Thrombosed Type A Aortic Dissection: A Single Center Experience. AU - Chen,Yen-Yu, AU - Yen,Hsu-Ting, AU - Wu,Chia-Chen, AU - Kwan-Ru Huang,David, Y1 - 2019/11/16/ PY - 2019/10/03/received PY - 2019/11/10/revised PY - 2019/11/11/accepted PY - 2019/11/20/entrez PY - 2019/11/20/pubmed PY - 2019/11/20/medline KW - Retrograde type A aortic dissection KW - Thoracic endovascular aortic repair KW - Type A intramural hematoma JF - Annals of vascular surgery JO - Ann Vasc Surg N2 - OBJECTIVE: The aim of this study was to present our experience of thoracic endovascular aortic repair (TEVAR) for type A intramural hematoma (TAIMH) and retrograde thrombosed type A aortic dissection (rt-TAAD) with the entry tear in the descending aorta or the abdominal aorta and discuss the outcomes. MATERIAL AND METHODS: We retrospective reviewed total 6 patients who underwent TEVAR for TAIMH (n = 2) or rt-TAAD (n = 4) in our hospital between September 2017 and July 2019. The mean age of the patients (5 men and 1 woman) was 74 ± 13 years, and the mean follow-up duration was 13 ± 7 months. RESULTS: TEVAR was successfully performed in the acute phase in all patients without relevant complications. After TEVAR, the shrinkage of enlarged thoracic aorta and complete resorptions of the false lumen of the entire thoracic aorta were achieved in 4 patients. In the remaining 2 patients, one had residual thrombosed false lumen of the ascending aorta due to a new development of PAU at the distal aortic arch and another need additional endovascular intervention for ascending aorta hematoma progression. Late aorta-related adverse event was observed in 1 patient, who needed open aortic repair. There was no death during follow-up. CONCLUSIONS: Tear-oriented endovascular aortic repair is a potential option in selected patients of TAIMH and rt-TAAD and has shown favorable immediate outcomes and aortic remodeling. However, the late aorta-related adverse event is not negligible, and their long-term outcome has not been fully clarified. More research is warranted. SN - 1615-5947 UR - https://www.unboundmedicine.com/medline/citation/31743779/Thoracic_Endovascular_Aortic_Repair_for_Type_A_Intramural_Hematoma_and_Retrograde_Thrombosed_Type_A_Aortic_Dissection:_A_Single_Center_Experience L2 - https://linkinghub.elsevier.com/retrieve/pii/S0890-5096(19)30978-1 DB - PRIME DP - Unbound Medicine ER -