 |
|
|
|
|
|
Mid-Term Results With TEVAR for Chronic Type B Aortic Dissection with Associated Aneurysm Cyrus J Parsa, Judson B Williams, Syamal Dave Bhattacharya, *Walter G Wolfe, Richard L McCann, G Chad HughesDuke University Medical Center, Durham, NC OBJECTIVES: The use of thoracic endovascular aortic repair (TEVAR) for complicated chronic Type B aortic dissection with associated descending thoracic aneurysm remains controversial. Concerns include potential ischemic complications due to branch vessel origin from the chronic false lumen as well as continued retrograde false lumen/aneurysm sac pressurization via fenestrations distal to implanted endografts. The purpose of the present study was to examine mid-term results with TEVAR for chronic (>2 weeks) Type B aortic dissection with associated aneurysm so as to better understand the potential role of TEVAR for this condition. METHODS: Between 3/05 (date of initial FDA approval) - 12/09, n=51 TEVAR procedures were performed at a single institution for management of chronic Type B dissection. The indication for TEVAR was aneurysm in all cases. A subset of n=7 patients (13.7%) underwent placement of EndoSureTM wireless pressure measurement system (CardioMEMS, Inc., Atlanta, Georgia) in the false lumen adjacent to the primary tear for monitoring aneurysm sac/false lumen pulse pressure (ASP) status-post TEVAR. Devices utilized were Gore TAG (n=36; 70.6%), Zenith TX2 (n=12; 23.5%), and Medtronic Talent (n=1; 2%); n=2 (3.9%) patients received more than one type of device. Nearly half the cohort (n=24; 47.1%) had prior aortic surgery including open AAA repair (n=3; 12.5%), endovascular aortic repair (n=2; 8.3%), open descending thoracic aortic repair (n=5; 20.8%), or prior Type A dissection or arch repair (n=14; 58.3%). RESULTS: Mean patient age was 57±12 years (range 30-82) and n=14 (27.5%) were female. Mean aortic diameter was 6.2+1.4 cm. There were no in-hospital/30-day deaths, strokes, or permanent paraplegia/paresis. There were no complications related to compromise of downstream branch vessels arising from the false lumen. N=2 patients (3.9%) who had pre-existing ascending aortic dilation suffered retrograde acute Type A aortic dissection following implantation of a Zenith TX2 device, which has proximal barbs for fixation; both were repaired successfully. Median post-op LOS was 4 days (range 1-49 days). At a mean follow-up of 12.1±12.5 months (range 1-51 months), all cause mortality was 15.7% (n=8). There was a single late aortic death (2.0%) from endograft infection. N=4 patients (7.8%) required secondary endovascular re-intervention for Type I endoleak, whereas n=3 (5.9%) required additional distal endografting for downstream aortic dilatation; re-intervention was successful in all cases. N=2 patients (3.9%) required late conversion to open repair, one for endograft infection and one for continued sac expansion; the single late aortic death occurred following endograft removal for infection. All n=7 patients with EndoSureTM wireless pressure measurement system exhibited a decrease in ASP indicating a depressurized false lumen. The ASP ratio decreased from 52±27% at the pre-discharge measurement to 14±5% at the latest follow-up reading (p=0.029). CONCLUSIONS: This series demonstrates that TEVAR for chronic Type B dissection is safe and effective at early mid-term follow-up. ASP measurements demonstrate a significant reduction in false lumen endotension thus ruling out clinically significant persistent retrograde false lumen perfusion and provide proof of concept for a TEVAR-based approach. Longer-term follow-up is needed to determine the durability of TEVAR for this aortic pathology. Back to Scientific Program Back to 2010 Annual Meeting
|
||||||||||||||||||||||||||||||||||||||||||||
| Home | About WTSA | Contact Us | www.westernthoracic.org |