Advance Scheduled Treatment for Type B Acute Aortic Dissection

Hiroyuki Yamamoto, Kenji Toyokawa, Kazuhisa Matsumoto, Kenichi Arata, Itsumi Imagama, Hideaki Kanda, Tomoyuki Matsuba, Shuji Nagatomi, Yuki Ogata, Naoki Tateishi, Yutaka Imoto

Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan

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

Abstract

Recently thoracic endovascular repair (TEVAR) has been widely performed for Type B acute aortic dissection(TBAD).TEVAR is highly effective in aortic remodeling with aneurysm sac stabilization or regression in dissections limited to the descending thoracic aorta. In more extensive dissections involving the entire distal aorta TEVAR is also effective in the thoracic aortic dimensions, but the abdominal aortic false lumen remains patent and is at high risk for expansion. We report a therapeutic strategy to stabilize dissection of the abdominal aorta by stepwise treatment for remaining reentry to prevent aneurysmal change. 45 patients with TBAD were treated by TEVAR from 2014 to 2017. We have two treatment strategy. Full metal jacket (FMJ) method; TEVAR is performed at the onset of aortic dissection, then reentry is closed with EVAR, and the space between the two stent grafts is covered with a bare stent. ECLIPSE method; After first TEVAR, replacement of the abdominal aorta below the renal artery with a prosthetic graft and insert the next stent graft between the first stent graft and the prosthetic graft. Seven cases were treated by FMJ and ECLIPSE was performed in three cases. Operative mortality was 0%. Complete false lumen thrombosis and aortic remodeling were obtained in 2 case. Thrombosis around the reentry was not obtained, but slow aortic remodeling was observed in 3 cases at the site distant from reentry. Because of the small number of cases and the short observation period, this treatment strategy is not yet clear about the contribution to long-term prognosis after TEVAR performed for aortic dissection. Further examination is necessary, but the success cases suggested the importance of closure of the entry.