[MO-80] Presentation Awards
4-year result of TEVAR procedures for acute type B aortic dissection in China Medical University Hospital
Background: Thoracic Endovascular aortic repair ( TEVAR ) is Class I recommendation for complicated acute type B aortic dissection ( BAAD ). The perioperative mortality, early/late complications and remodeling of aorta are concerned if we extend the indications to nearly all BAAD.
Methods: From Jan. 2014 to Jul. 2018, TEVAR procedures were applied to nearly all BAAD patients in our Hospital. Atypical BAAD including traumatic aortic injury and intramural hematoma was excluded. The discrepancy between initial indications and peer-reviewer’s indications was noted. The procedure details and postoperative results were recorded. The series of post-operative CT were reviewed to define false lumen thrombosis and diameter change of 6 segments of aorta. The causes of mortality, ischemic stroke, renal artery compromise and re-intervention were discussed.
Results: Total 46 patients, aged 24 to 85(mean 55 ), 35 males and 11 females were scheduled for TEVAR procedure for BAAD in mean 18.9hrs from visit to operation room. Mean 2.1 aortic stents ( 26% tapered) were mainly deployed with proximal zone 2 and distal T8th landing combined with 18 rChimney, 3 aChimney, 2 coil embolization, 1 ligation and 1 fenestration to left subclavian artery and 7 iliac stents etc. Patient were discharged on postoperative day 2-120 (mean 11). There were 8.7% 30-day mortality, 19.6% early complications including ischemic bowel, limb weakness, retrograde dissection, stroke etc. and 23.9% late complications including chronic respiratory failure, pSINE, dSINE, renal infarction, chimney graft occlusion etc. 70.7% patients could have Class 2-3 false lumen thrombosis. The re-intervention rate was 25.6%.
Conclusion: Extended indication of TEVAR for non-complicated BAAD is appreciable since the morbidity and mortality are acceptable and mid-term false lumen thrombosis is promising. More delicate branch vessel revasculization and avoiding retrograde dissection might decrease re-intervention rate.
Methods: From Jan. 2014 to Jul. 2018, TEVAR procedures were applied to nearly all BAAD patients in our Hospital. Atypical BAAD including traumatic aortic injury and intramural hematoma was excluded. The discrepancy between initial indications and peer-reviewer’s indications was noted. The procedure details and postoperative results were recorded. The series of post-operative CT were reviewed to define false lumen thrombosis and diameter change of 6 segments of aorta. The causes of mortality, ischemic stroke, renal artery compromise and re-intervention were discussed.
Results: Total 46 patients, aged 24 to 85(mean 55 ), 35 males and 11 females were scheduled for TEVAR procedure for BAAD in mean 18.9hrs from visit to operation room. Mean 2.1 aortic stents ( 26% tapered) were mainly deployed with proximal zone 2 and distal T8th landing combined with 18 rChimney, 3 aChimney, 2 coil embolization, 1 ligation and 1 fenestration to left subclavian artery and 7 iliac stents etc. Patient were discharged on postoperative day 2-120 (mean 11). There were 8.7% 30-day mortality, 19.6% early complications including ischemic bowel, limb weakness, retrograde dissection, stroke etc. and 23.9% late complications including chronic respiratory failure, pSINE, dSINE, renal infarction, chimney graft occlusion etc. 70.7% patients could have Class 2-3 false lumen thrombosis. The re-intervention rate was 25.6%.
Conclusion: Extended indication of TEVAR for non-complicated BAAD is appreciable since the morbidity and mortality are acceptable and mid-term false lumen thrombosis is promising. More delicate branch vessel revasculization and avoiding retrograde dissection might decrease re-intervention rate.