Type A Aortic Dissection After Thoracic Endovascular Aortic Repair

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• 作者：Takatoshi Higashigawa ; MD^a ; ^{mar.adriatico0501@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Noriyuki Kato ; MD^a ; Shuji Chino ; MD^a ; Takashi Hashimoto ; MD^a ; Hideto Shimpo ; MD^b ; Toshiya Tokui ; MD^c ; Toru Mizumoto ; MD^d ; Tomoaki Sato ; MD^e ; Manabu Okabe ; MD^f ; Hajime Sakuma ; MD^a
• 刊名：The Annals of Thoracic Surgery
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：102
• 期：5
• 页码：1536-1542
• 全文大小：585 K

文摘

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.