Clinical Interventions in Aging (Nov 2018)
Aortic remodeling in Type B aortic dissection after thoracic endovascular aortic repair with an aortic extender cuff implantation
Abstract
Honggang Zhang,1 Tong Qiao2 1Department of Vascular Surgery, Lianyungang Clinical College of Nanjing Medical University, Lianyungang 222000, Jiangsu, China; 2Department of Vascular Surgery, Gulou Clinical College of Nanjing Medical University, Nanjing 210000, Jiangsu, China Objective: This study investigated the safety and efficiency of thoracic endovascular aortic repair (TEVAR) plus an aortic extender cuff placement in treating Stanford Type B aortic dissections (TBADs). Methods: Clinical data on 157 patients with TBADs who underwent TEVAR in two tertiary medical centers from February 2013 to March 2018 were analyzed retrospectively. An estimated mismatch rate >120% was the indication for placement of an aortic extender cuff. Results in the perioperative and follow-up periods (≥3 months) were analyzed, especially those of aortic remodeling. Results: In total, 106 patients (67.5%) underwent standard TEVAR, and 51 (32.5%) received TEVAR plus an aortic extender cuff placement. The primary technical success rate was 96.8% (152/157). Perioperative adverse events included endoleak (2%, 3/157), spinal cord ischemia (SCI) (1.3%, 2/157), and transient renal failure (0.6%, 1/157), with no between-group differences. The median follow-up was 15 months (range 3–71 months). Ten cases of late stent complications were observed, including three endoleak, one upper limb ischemia, one stent distortion, and five stent graft-induced distal re-dissection (SIDR). Patients with a cuff had less distal re-dissection and fewer second interventions, but the differences lacked significance. In the last follow-up, the TEVAR+Cuff group were found to have better true lumen recovery and false lumen shrinkage, and increased complete false lumen thrombosis in the thoracic and abdominal segments; however, no statistical difference was evident in comparison with the TEVAR group (P>0.05). Conclusion: TEVAR plus an aortic extender cuff implantation improves remodeling of the dissected thoracic aorta, thus reducing the potential of SIDR. Furthermore, the covered stent with a length of 250 mm does not increase the rate of SCI or paraplegia. However, these results should be confirmed in a larger series of patients with longer follow-up. Keywords: Type B aortic dissection, thoracic endovascular aortic repair, aortic extender cuff, aortic remodeling
