Strategy of TEVAR for acute aortic dissection

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Strategy of TEVAR for acute aortic dissection

• Osaka University Graduate school of Medicine,
• Division of Cardiovascular surgery
• Takuya Yoshida, Toru Kuratani, Kazuo Shimamura,
  Yukitoshi Shirakawa, Mugiho Takeuchi, Keiwa Kin,
  Yoshiki Sawa

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Strategy of TEVAR for acute aortic dissection
Minimal coverage of each thoracic intimal tear
(short stent graft) Strict sizing (proximal
110-115, distal -110)
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Objective
To assess the outcome of TEVAR for acute aortic
dissection with minimal intimal tear closure.
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Patient demographics
Primary TEVAR for aortic dissection (1998-2009)
in acute phase (lt2week) 36 cases
Age 61.510.3 Gender (M/F)
21 / 10 Type of dissection
Type
A 7 Type B 29
complicated Type B
17 uncomplicated Type B
12
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Device selection
Homemade
29 Homemade TAG 1 Homemade
Excluder cuff 2 TAG
2 Excluder cuff
2
Average length of the stent-graft 10.3 cm
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Representive case
Pre operation
Post operation
3.3cm
Gore Aortic Extender Cuff
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Early Results

• Operative outcome
• Procedure success 36/36
  (100)
• Mortality 2 /36 (5.6)
• 
  (arrhythmia, intestinal necrosis)
• Morbidity
• Stroke 0
• Spinal cord ischemia 0
• Retrograde type A dissection 0
• intimal tear creation 0
• Iliac rupture 0
• Endoleak at 1st postoperative CT 1
  /36 (2.8)

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Diameter of DTA
Thoracic false lumen thrombosis
32/36 (88.9)
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Freedom from aortic death
follow up average 30.132.0 month, max 129month
Stanford A 100
Uncomplicated type B 100
Freedom from aortic death ()
Over all 94.4
Complicated type B 88.2
month
10
Long term results Aortic event
Stanford A
event POM procedure
proximal ULP 3 TEVAR
Ascending Ao ULP 7 TAR
Stanford B
event POM procedure
proximal ULP 5 TEVAR
distal endoleak 6 TEVAR
proximal distal ULP 14 TARTEVAR
iliac aneurysm 19 graft replacement
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Freedom from aortic event
12
Conclusions
TEVAR with minimal coverage of each thoracic
intimal tear provided good early phase
protection. Although further investigation is
necessary regarding late aortic events, this
strategy may achieve the goal of false lumen
thrombosis, without incurring the risks of
covering the whole aorta.