Thoracic Endovascular Aortic Repair for Complicated Type B Acute Aortic Dissection with Acute Limb Ischemia

Takanori Tsujimoto, Naomichi Uchida, Syota Hasegawa, Kanetsugu Nagao, Motoharu Kawashima, Yoshikatsu Nomura, So Izumi, Masamichi Matsumori, Hirohisa Murakami, Tasuku Honda, Masato Yoshida, Nobuhiko Mukohara

Department of Cardiovascular surgery, Hyogo Brain and Heart Center, Hyogo, Japan

Date, time and location: 2018.05.26 17:00, Congress Hall, 2F–A

Abstract

The effectiveness of emergent TEVAR for complicated type B dissection (cTBAD) has been established. The purpose of this study was to investigate the therapeutic strategy in cTBAD with acute limbs ischemia. [Method] Six cases who treated with emergent TEVAR for cTBAD with acute limbs ischemia from November 2011 to September 2017. The age was 59.7±6.9 years old, and all cases man. Enhanced computed tomography (CT) shows false lumen was patent in five, thrombosed in one, extend of dissection spread to an iliac artery in four, and dynamic aortic obstruction of visceral artery in five. It was 6.3±2.1 hours from an ischemic symptom to the TEVAR. The stent-grafts was located from intact aorta (Zone 2 in three, Zone 3 in two, Zone 4 in one) to mid descending aorta. [Result] the all cases TEVAR were succeeded, and early death, the cerebral infarction, and spinal cord ischemia did not occur. Bare stent was added to for iliac artery or renal artery at the same time of TEVAR in 3 (iliac artery = 1, renal artery = 2). Additional treatments were replaced in two after TEVAR. (Intervention of renal artery, and PETTICOAT technique). Serum creatine concentration was 1.3±0.3 mg/dl at discharge. Follow up term was 770±620 days after operation. There are no death, aortic event, new tear and retrograde dissection. False lumen of thoracic aorta was completely regressed in three and regressed more than 5mm in three. [Conclusion] The early results of TEVAR for cTBAD with acute lower limbs ischemia were good. In case of renal malperfusion, intervention of iliac or renal artery was sometimes necessary, and it was necessary to consider PETTICOAT technique in which true lumen expansion had poor. Postoperative aorta remodeling was good, but careful and regular follow-up CT examinations are required.