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Thoracic Endovascular Aortic Repair for Type B Aortic Dissection Associated with Retrograde Type A Intramural Hematoma.
J Vasc Interv Radiol. 2020 Aug; 31(8):1334-1341.JV

Abstract

PURPOSE

To evaluate feasibility and efficacy of thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD) associated with retrograde type A intramural hematoma (IMH).

MATERIALS AND METHODS

From April 2013 to January 2017, 15 consecutive patients with TBAD associated with retrograde type A IMH who underwent TEVAR were reviewed retrospectively. There was no cardiac tamponade, aortic regurgitation, involvement of coronary artery, or sign of cerebral ischemia in these patients. Enhanced CT was used in 4 patients to diagnose malperfusion of abdominal visceral arteries or lower extremity artery and underwent emergent TEVAR. For the remaining 11 patients, repeated enhanced CT after initial medical treatment within 24 hours from onset of pain showed expansion of IMH in 8 patients or presence of periaortic hematoma in 3 patients. Delayed TEVAR was scheduled for these cases.

RESULTS

Successful deployment of the stent graft was achieved in all patients. There were no severe postoperative complications, such as retrograde type A aortic dissection or aortic rupture. Sudden death occurred in 1 patient 3 months after the procedure. Thrombosis of the false lumen, shrinkage of the diameter of the aorta, and complete absorption of the IMH were observed in the remaining patients at a mean follow-up of 19.8 months ± 6.57.

CONCLUSIONS

TEVAR for treatment of TBAD with retrograde type A IMH is feasible and effective. It represents a treatment option for patients with TBAD associated with type A IMH with a proximal entry tear located in the descending aorta.

Authors+Show Affiliations

Department of Intervention Medicine, the Second Hospital of Shandong University, 247 Beiyuan Road, Jinan 250033, Shandong, People's Republic of China; Interventional Oncology Institute of Shandong University, Jinan, Shandong, People's Republic of China.Department of Intervention Medicine, the First Hospital of Nanping Affiliated to Fujian Medical University, Nanping, Fujian, China.Department of Radiology, Ben Gurion University of the Negev, Beersheba, Israel.Department of Intervention Medicine, the Second Hospital of Shandong University, 247 Beiyuan Road, Jinan 250033, Shandong, People's Republic of China; Interventional Oncology Institute of Shandong University, Jinan, Shandong, People's Republic of China.Department of Intervention Medicine, the Second Hospital of Shandong University, 247 Beiyuan Road, Jinan 250033, Shandong, People's Republic of China; Interventional Oncology Institute of Shandong University, Jinan, Shandong, People's Republic of China.Department of Intervention Medicine, the Second Hospital of Shandong University, 247 Beiyuan Road, Jinan 250033, Shandong, People's Republic of China; Interventional Oncology Institute of Shandong University, Jinan, Shandong, People's Republic of China.Department of Intervention Medicine, the Second Hospital of Shandong University, 247 Beiyuan Road, Jinan 250033, Shandong, People's Republic of China; Interventional Oncology Institute of Shandong University, Jinan, Shandong, People's Republic of China.Department of Intervention Medicine, the Second Hospital of Shandong University, 247 Beiyuan Road, Jinan 250033, Shandong, People's Republic of China; Interventional Oncology Institute of Shandong University, Jinan, Shandong, People's Republic of China.Department of Intervention Medicine, the Second Hospital of Shandong University, 247 Beiyuan Road, Jinan 250033, Shandong, People's Republic of China; Interventional Oncology Institute of Shandong University, Jinan, Shandong, People's Republic of China. Electronic address: xiguachanghaiyang@163.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32127315

Citation

Li, Yu-Liang, et al. "Thoracic Endovascular Aortic Repair for Type B Aortic Dissection Associated With Retrograde Type a Intramural Hematoma." Journal of Vascular and Interventional Radiology : JVIR, vol. 31, no. 8, 2020, pp. 1334-1341.
Li YL, Ye JC, Yancu H, et al. Thoracic Endovascular Aortic Repair for Type B Aortic Dissection Associated with Retrograde Type A Intramural Hematoma. J Vasc Interv Radiol. 2020;31(8):1334-1341.
Li, Y. L., Ye, J. C., Yancu, H., Liu, B., Wang, Y. Z., Wang, W. J., Wang, W., Li, D., & Chang, H. Y. (2020). Thoracic Endovascular Aortic Repair for Type B Aortic Dissection Associated with Retrograde Type A Intramural Hematoma. Journal of Vascular and Interventional Radiology : JVIR, 31(8), 1334-1341. https://doi.org/10.1016/j.jvir.2020.01.017
Li YL, et al. Thoracic Endovascular Aortic Repair for Type B Aortic Dissection Associated With Retrograde Type a Intramural Hematoma. J Vasc Interv Radiol. 2020;31(8):1334-1341. PubMed PMID: 32127315.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Thoracic Endovascular Aortic Repair for Type B Aortic Dissection Associated with Retrograde Type A Intramural Hematoma. AU - Li,Yu-Liang, AU - Ye,Jia-Cheng, AU - Yancu,Hertzanu, AU - Liu,Bin, AU - Wang,Yong-Zheng, AU - Wang,Wu-Jie, AU - Wang,Wei, AU - Li,Dong, AU - Chang,Hai-Yang, Y1 - 2020/02/29/ PY - 2019/10/25/received PY - 2020/01/03/revised PY - 2020/01/20/accepted PY - 2020/3/5/pubmed PY - 2020/11/3/medline PY - 2020/3/5/entrez SP - 1334 EP - 1341 JF - Journal of vascular and interventional radiology : JVIR JO - J Vasc Interv Radiol VL - 31 IS - 8 N2 - PURPOSE: To evaluate feasibility and efficacy of thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD) associated with retrograde type A intramural hematoma (IMH). MATERIALS AND METHODS: From April 2013 to January 2017, 15 consecutive patients with TBAD associated with retrograde type A IMH who underwent TEVAR were reviewed retrospectively. There was no cardiac tamponade, aortic regurgitation, involvement of coronary artery, or sign of cerebral ischemia in these patients. Enhanced CT was used in 4 patients to diagnose malperfusion of abdominal visceral arteries or lower extremity artery and underwent emergent TEVAR. For the remaining 11 patients, repeated enhanced CT after initial medical treatment within 24 hours from onset of pain showed expansion of IMH in 8 patients or presence of periaortic hematoma in 3 patients. Delayed TEVAR was scheduled for these cases. RESULTS: Successful deployment of the stent graft was achieved in all patients. There were no severe postoperative complications, such as retrograde type A aortic dissection or aortic rupture. Sudden death occurred in 1 patient 3 months after the procedure. Thrombosis of the false lumen, shrinkage of the diameter of the aorta, and complete absorption of the IMH were observed in the remaining patients at a mean follow-up of 19.8 months ± 6.57. CONCLUSIONS: TEVAR for treatment of TBAD with retrograde type A IMH is feasible and effective. It represents a treatment option for patients with TBAD associated with type A IMH with a proximal entry tear located in the descending aorta. SN - 1535-7732 UR - https://www.unboundmedicine.com/medline/citation/32127315/Thoracic_Endovascular_Aortic_Repair_for_Type_B_Aortic_Dissection_Associated_with_Retrograde_Type_A_Intramural_Hematoma_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1051-0443(20)30032-4 DB - PRIME DP - Unbound Medicine ER -