Strategy of Thoracic Endovascular Aortic Repair for Acute ...
Strategy of TEVAR for acute aortic dissection Osaka University Graduate school of Medicine, Division of Cardiovascular surgery Takuya Yoshida, Toru Kuratani, Kazuo Shimamura, Yukitoshi Shirakawa, Mugiho Takeuchi, Keiwa Kin, Yoshiki Sawa
Strategy of TEVAR for acute aortic dissection ・ Minimal coverage of each thoracic intimal tear (short stent graft) ・ Strict sizing (proximal 110-115%, distal -110%)
To assess the outcome of TEVAR for acute aortic dissection with minimal intimal tear closure. Objective
Patient demographics Primary TEVAR for aortic dissection (1998 － 2009) in acute phase (<2week) 36 cases Age 61.5±10.3 Gender (M/F) 21 / 10 Type of dissection Type A 7 Type B 29 complicated Type B 17 uncomplicated Type B 12
Device selection Homemade 29 Homemade + TAG 1 Homemade + Excluder cuff 2 TAG 2 Excluder cuff 2 Average length of the stent-graft 10.3 cm
Representive case Pre operation Post operation Gore Aortic Extender Cuff 3.3cm
Early Results <ul><li>Operative outcome </li></ul><ul><li>Procedure success 36/36 (100%) </li></ul><ul><li>Mortality 2 /36 (5.6%) </li></ul><ul><li>(arrhythmia, intestinal necrosis) </li></ul><ul><li>Morbidity </li></ul><ul><li>Stroke 0 </li></ul><ul><li>Spinal cord ischemia 0 </li></ul><ul><li>Retrograde type A dissection 0 </li></ul><ul><li>intimal tear creation 0 </li></ul><ul><li>Iliac rupture 0 </li></ul><ul><li>Endoleak at 1 st postoperative CT 1 /36 (2.8%) </li></ul>
Diameter of DTA Thoracic false lumen thrombosis 32/36 (88.9%) 40 30 Pre Post 6m 1y 3y 5y 7y 35 Duration from TEAVR Maximum diameter (mm) P=.0091 TEVAR
follow up: average 30.1±32.0 month, max 129month Freedom from aortic death Stanford A: 100% Uncomplicated type B: 100% Complicated type B: 88.2% month Freedom from aortic death (%) Over all: 94.4%
Stanford B Stanford A Long term results: Aortic event event POM procedure proximal ULP 3 TEVAR Ascending Ao ULP 7 TAR event POM procedure proximal ULP 5 TEVAR distal endoleak 6 TEVAR proximal + distal ULP 14 TAR+TEVAR iliac aneurysm 19 graft replacement
Freedom from aortic event Type A: 50%/5year, 50%/10year Overall: 69.9%/5year, 69.9%/10year Type B: 71.8%/5year, 71.8%/10year Freedom from aortic event (%) month
Conclusions ・ TEVAR with minimal coverage of each thoracic intimal tear provided good early phase protection. ・ Although further investigation is necessary regarding late aortic events, this strategy may achieve the goal of false lumen thrombosis, without incurring the risks of covering the whole aorta.
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