Treatment strategies and outcomes of endovascular repair of Stanford type B aortic dissection accompanied with retrograde type A aortic dissection / 中华放射学杂志

ABSTRACT

Objective:To investigate the treatment strategies for the thoracic endovascular aortic repair (TEVAR) of Stanford type B aortic dissection (TBAD) accompanied with intra-or post-operational retrograde type A aortic dissection (RAAD).Methods:TBAD patients who underwent TEVAR in Henan Provincial People′s Hospital from February 2004 to January 2020 were retrospectively analyzed. Among 1 176 cases, 14 cases (1.2%) were accompanied with RAAD. Another 9 patients who received TEVAR at other hospitals with TBAD accompanied with RAAD were also collected. In total 23 patients [18 males and 5 females, age as (54±12) years old , ranging from 38 to 79] were included in this study. There were 15 cases of typical dissection, 7 cases of intramural haematoma, and 1 case of penetrating aortic ulcer. Sixteen patients received surgical operation, 1 received hybrid surgery, and the remaining 6 patients underwent conventional therapies. The clinical data and followed up data were collected and analyzed.Results:Among 23 cases, 2 RAAD cases were discovered during the TEVAR, 8 cases were discovered during the perioperative period, 5 cases were discovered within 3 months after discharge, and 8 cases were discovered at more than 1 year after TEVAR, with the longest time point of 120 months after TEVAR. The RAAD rupture was located on the greater curvature side of the aorta in 21 cases, and on the minor curvature side in 2 cases. In 13 cases, the rupture was close to the stent head, and in 10 cases, the rupture was located on the ascending aorta and more than 2 cm from the stent head. Followed up data were collected in 21 cases, with the mean follow-up time as (59±40) months, ranging from 1 to 134 months. Six patients died, with 3 cases of all-reason death and 3 cases of cardiac-reason death. Among the 16 patients receiving surgical operation, one patient died during the perioperative period, and 1 patient suffered from the cerebral infarction and mediastinal infection. Well recovery was found in 1 patient received the hybrid operation. Five of 6 patients who received the conventional treatment died.Conclusions:RAAD is a serious complication related to TEVAR, with low incidence and high mortality rate. RAAD can occur in the early or late stages of TEVAR. TEVAR-associated RAAD has poor therapeutic outcomes, and the surgical operation should be recommended as the preferred treatment for RAAD in clinical practice.