pubmed.ncbi.nlm.nih.gov

Staging reinterventions for remodeling of residual aortic dissection: a single-center retrospective study - PubMed

  • ️Mon Jan 01 2024

Staging reinterventions for remodeling of residual aortic dissection: a single-center retrospective study

Bailang Chen et al. Front Cardiovasc Med. 2024.

Abstract

Objective: Inadequate remodeling of residual aortic dissection (RAD) following repair of Stanford A or B aortic dissections has been identified as a significant predictor of patient mortality. This study evaluates the short- to mid-term outcomes of staged reinterventions for RAD at a single center with prospective follow-up.

Methods: Data were retrospectively collected from patients with RAD who underwent staged reinterventions or received none-surgery treatment in the Cardiovascular Surgery Department of our hospital between July 2019 and December 2021. The cohort included 54 patients with residual distal aortic dissection post-primary surgery, comprising 28 who underwent open surgery and 26 who received thoracic endovascular aortic repair (TEVAR). Patients were divided into two groups: those who underwent staged stent interventions for distal dissection [staged reintervention (SR) group] and those who did not undergo surgery (non-surgery group). For the SR group, second or third staged stent interventions were performed. The study assessed distal remodeling of aortic dissection between the groups, focusing on endpoints such as mortality (both general and aortic-specific), occurrences of visceral branch occlusion, necessity for further interventions, and significant adverse events. Morphological changes were analyzed to determine the therapeutic impact.

Results: The study encompassed 54 participants, with 33 in the SR group and 21 in the non-surgical control group. Baseline demographics and clinical characteristics were statistically comparable across both groups. During an average follow-up of 31.5 ± 7.0 months, aortic-related mortality was 0% in both groups; all-cause mortality was 3% (one case) and 5% (one case) in the SR and control groups, respectively, with no statistically significant difference noted. In the SR group, a single patient experienced complications, including renal artery thrombosis, leading to diminished blood flow. An increased true lumen (TL) area and a decreased false lumen area at various aortic planes were observed in the SR group compared to the control group.

Conclusion: The staged reintervention strategy for treating RAD is safe and provides promising early results.

Keywords: aortic remodeling; endovascular aortic repair; entry tear; residual aortic dissection; staging reintervention.

© 2024 Chen, Huang, Zhuang, Wang and Wei.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1

True and FL diameters were measured using a straight line that passes through the midpoint of the intima and the center of the circle. Measurements were taken at the following locations: (A) the distal end of the primary stent; (B) the celiac trunk opening; (C) 5 cm below the renal arteries; (D) 1 cm below the iliac artery bifurcation.

Figure 2
Figure 2

Illustration of the staging reintervention for the remodeling of residual aortic dissection: residual dissection entry tear following the first-stage operation (A); second-stage and third-stage operations respectively (B, C). This is accompanied by a three-dimensional reconstruction of the thoracic and abdominal aorta following stent implantation (D) Black arrow: entry tear; yellow: coil.

Figure 3
Figure 3

The first row displays preoperative CT images, the second row presents CT images taken three months after the second-stage surgery, and the third row features follow-up CT images taken one year after the second-stage surgery. From left to right, the images respectively show sections of aortic dissection at the distal end plane of the primary stent, the renal artery level, 5 cm below the renal artery level, and 1 cm below the bifurcation of the iliac artery. After initial surgery, zones (A–D) exhibited a residual FL that had not fully thrombosed (A1-A4). Three months after the second-stage surgery, the aortic CTA revealed TL re-expansion without any obvious entry tears; follow-up observation was subsequently continued (B1-B4). One year after second-stage surgery, aortic CTA revealed that the FL had completely thrombosed and disappeared (C1-C4).

Figure 4
Figure 4

Cumulative kaplan-meier estimate for freedom from all-cause mortality in the SR group (solid red line) and the control group (solid black line).

Figure 5
Figure 5

Pie chart showing the status of aortic FL thrombosis following staging reintervention (n = 33).

Figure 6
Figure 6

Distal plane of the stent during initial surgery: the TL was narrowed and underwent significant expansion after the second-stage surgery (A1 and A2). The plane of the renal artery opening: After stents were placed in the right renal artery and abdominal artery, the TL of the visceral branch area expanded, and the FL completely disappeared (B1 and B2). The narrowest plane of the TL of the abdominal aorta below the renal artery: Both the TL expanded and the FL disappeared after stent placement (C1 and C2). After the stent placement in the external iliac artery to cover the iliac artery entry tear, the FL disappeared (D1, D2, E1, and E2).

Figure 7
Figure 7

Box plots for aortic measurements from 54 patients using actual measurement times before surgery and at the last follow-up computed tomography angiography (CTA). (A) staging reintervention (SR) group; (B) control group. (1): at the distal end plane of the primary stent; (2): at the plane of the celiac trunk opening; (3): 5 cm below the renal arteries; (4): 1 cm below the iliac artery bifurcation. TL, true lumen; FL, false lumen. *p < 0.001.

Similar articles

References

    1. Wada T, Yamamoto H, Takagi D, Kadohama T, Yamaura G, Kiryu K, et al. Aortic remodeling, reintervention, and survival after zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection: midterm results. JTCVS Tech. (2022) 14:29–38. 10.1016/j.xjtc.2022.05.013 - DOI - PMC - PubMed
    1. Berger T, Graap M, Rylski B, Fagu A, Gottardi R, Walter T, et al. Distal aortic failure following the frozen elephant trunk procedure for aortic dissection. Front Cardiovasc Med. (2022) 9:911548. 10.3389/fcvm.2022.911548 - DOI - PMC - PubMed
    1. Winnerkvist A, Lockowandt U, Rasmussen E, Rådegran K. A prospective study of medically treated acute type B aortic dissection. Eur J Vasc Endovasc Surg. (2006) 32:349–55. 10.1016/j.ejvs.2006.04.004 - DOI - PubMed
    1. Davies RR, Goldstein LJ, Coady MA, Tittle SL, Rizzo JA, Kopf GS, et al. Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size. Ann Thorac Surg. (2002) 73:17–27. 10.1016/s0003-4975(01)03236-2 - DOI - PubMed
    1. Fattori R, Cao P, De Rango P, Czerny M, Evangelista A, Nienaber C, et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J Am Coll Cardiol. (2013) 61:1661–78. 10.1016/j.jacc.2012.11.072 - DOI - PubMed

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article.