Endovascular Repair in Retrograde Type A Aortic Dissection with an Entry Tear Located in Descending Aorta

Zhi Zheng, You-Min Pan, Tian-Xin Xiong

Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China

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

Abstract

Objective: To report the early and mid-term outcome of thoracic endovascular aortic repair (TEVAR) in highly selected patients with acute Stanford type A aortic dissection with an entry tear located in descending aorta, namely retrograde type A aortic dissection (RTAAD).

Methods: From 2013 to 2016, 43 clinically stable RTAAD patients were recruited in our study. Inclusion criteria were as follows: (1) acute RTAAD demonstrated by computed tomography angiography (CTA) without any entry tear in ascending aorta or proximal aortic arch; (2) no signs of cardiac tamponade or severe aortic regurgitation; (3) no signs of ischemia of coronary artery or arch branches; (4) no previous history of cardiac or aortic surgery; (5) role out the possibility of Marfan syndrome or other connective tissue disorders. TEVAR was done through a femoral artery route. Left subclavian artery was intentionally occluded in sixteen patients, reconstructed through fenestration technique in six and hybrid procedure in two, and remained uninfluenced or partialoccluded in the rest nineteen patients.

Results: No stroke, or paraplegia, or new intimal tear in the proximal ascending aorta, or endoleak was observed during perioperative period. Postoperative morbidity rate was 7%. There was one perioperative death (2%). During follow-up period (12~36 months), no aortic related event was reported. CTA showed TEVAR resulted in complete thrombosis of false lumen, reabsorption of false lumen thrombus, and enlargement of true lumen. Mean maximal area of false lumen in ascending aorta significantly decreased (941±214mm² vs. 631±301 mm², P<0.01) after TEVAR. At the distal edge of stent graft, mean whole area of descending aorta remained stable (739±198mm² vs. 721±236 mm², P>0.05) after TEVAR.

Conclusions:TEVAR is a safe and effective technique in highly selected patients for the treatment of RTAAD. However, further large-scale follow-up studies are required to verify its long-term efficacy.