Original article
Adult cardiac
Type A Aortic Dissection After Thoracic Endovascular Aortic Repair

https://doi.org/10.1016/j.athoracsur.2016.04.024Get rights and content

Background

Type A aortic dissection (TAAD) is a rare complication associated with thoracic endovascular aortic repair (TEVAR). Although TAAD can result in catastrophic outcomes, the pathology of the condition has not been thoroughly clarified yet.

Methods

We retrospectively reviewed details from the medical records of 546 patients with diseases of the thoracic aorta (thoracic aortic aneurysm, n = 362; aortic dissection, n = 178; and fistula between the descending thoracic aorta and esophagus, n = 6) who underwent TEVAR in five hospitals from May 1997 through February 2015 to identify patients in whom TAAD developed during or after TEVAR.

Results

TEVAR-associated TAAD developed in 12 patients (2.2%). Pathologies originally treated with TEVAR were aortic dissection in 10 patients (83%) and true thoracic aortic aneurysm in 2 (17%). Type A aortic dissection developed during hospitalization in 4 patients (33%), within 1 year in 5 (42%), and more than 1 year later in 3 (25%). The entry tear was located in the ascending aorta or the aortic arch away from the edges of stent grafts in 8 patients (67%), whereas it was found just at the proximal edges of stent grafts in 4 patients (33%). Nine patients underwent ascending aortic replacement with or without concomitant aortic arch replacement, and 3 patients underwent medical management. Overall, 2 patients (17%) died during hospitalization.

Conclusions

Type A aortic dissection can develop during TEVAR or even years after TEVAR. Careful operative procedures and follow-up should be mandatory for patients with aortic dissection as TAAD seems to occur more frequently among these patients.

Section snippets

Patients and Methods

We retrospectively reviewed details from the medical records of 546 patients (mean age, 70 ± 11 years; 409 men and 137 women) with diseases of the thoracic aorta (thoracic aortic aneurysm, n = 362; aortic dissection, n = 178; and fistula between the descending thoracic aorta and esophagus, n = 6) who underwent TEVAR in five hospitals from May 1997 to February 2015, to identify patients in whom TAAD developed during or after TEVAR. Among 178 patients with aortic dissection, 18 had de novo acute

Results

In 12 patients (2.2%, 12 of 546; mean age 70 ± 8 years; 7 men, 5 women), TAAD developed during or after TEVAR. Ten patients had undergone TEVAR for the treatment of aortic dissection (5.6%, 10 of 178), whereas the remaining 2 patients had undergone TEVAR for the treatment of other thoracic aortic diseases (0.5%, 2 of 368; p = 0.00 versus aortic dissection; Table 1). Among patients who had undergone TEVAR for aortic dissection, 3 (16.7%, 3 of 18) had undergone TEVAR for de novo acute retrograde

Comment

Development of TAAD after TEVAR is one of the most catastrophic events associated with TEVAR, with a reported incidence in the range of 1.3% to 6.8% in previous studies 8, 9, 10, 11. Patients who underwent TEVAR for the treatment of aortic dissection were more prone to have TAAD [8] and accounted for 83% of all patients (10 of 12) who had TAAD in our series. From the point of original aortic pathology, the frequency of TAAD was 5.6% among patients who underwent TEVAR for the treatment of aortic

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