Endovascular aortic repair in DeBakey type III aortic dissection: 13-year results of single center experience
Abstract
Aortic dissection is a life-threatening pathology with a high mortality rate if treated untimely. Endovascular aortic repair is used currently as a method of choice for surgical treatment of patients with DeBakey type III aortic dissection as an independent approach, as well as in case of staged hybrid surgical treatment. Despite of the problem topicality there is a lack of knowledge about the endovascular aortic repair long-term results. Also, complications of the long-term follow-up period are not well understood and arising in time requiring further changes in the treatment approach in order to prevent their development.
Material and methods. The clinical data of 72 patients (mean age 56.09±11.54 years; 61 men, 11 women), who underwent endovascular aortic repair during from 2006 to 2019 were analyzed.
Results. The average follow-up period was 4.24±3.50 years with maximal length of follow-up 13.5 years. At the moment of endovascular aortic repair 46 (63.89%) patients with a chronic stage of aortic dissection, 12 (16.67%) with subacute stage and 14 (19.44%) with acute stage were included. The total number of interventions was 80 including 8 reinterventions in 7 patients (9.72% of the total) performed due to development of the long-term follow-up period complica- tions (distal stent-graft induced new entry – dSINE, stent-graft dislocation). Taking into account censored cases during 13.5 years of follow-up period survival rate reached 66.45%. All-cause mortality in the analyzed group was 13 (18.05%) people, aortic-associated mortality was 8 (11.1%) people.
Conclusion. Patients with the chronic stage of DeBakey type III aortic dissection have a greater number of complications and deaths after endovascular aortic repair. Moreover, in the cases of endovascular aortic repair with conical stent-grafts were noted a smaller number of aorto-associated events.
Keywords:thoracic endovascular aortic repair, DeBakey type III aortic dissection, complications of TEVAR, stent-graft induced new entry (dSINE), stent-graft dislocation
Conflict of interests. The authors declare no conflict of interests.
For citation: Kudrinskiy A.V., Abugov S.A., Puretskiy M.V., Polyakov R.S., Mardanyan G.V., Pirkova A.A., Vartanyan E.L., Kraynikov D.A. Endovascular aortic repair in DeBakey type III aortic dissection: 13-years results of single center expeience. Clin Experiment Surg. Petrovsky J. 2020; 8 (2): 7–16. DOI: 10.33029/2308-1198-2020-8-2-7-16 (in Russian)
Received 06.12.2019. Accepted 26.03.2020
References
1. Khubulava G.G., Svetlikov A.V. Nikolai Leontyevich Volodos. History of unquestioned world priority in invention of vascular endoprosthesis. Vestnik khirurgii imeni I.I. Grekova [Grekov's Bulletin of Surgery]. 2017; 089 (092): 95–8. (in Russian)
2. Grabenwöger M., et al. Thoracic Endovascular Aortic Repair (TEVAR) for the treatment of aortic diseases: A position statement from the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2012; 33 (13): 1558–63.
3. Suzuki T., et al. Clinical profiles and outcomes of acute type B aortic dissection in the current era: Lessons from the International Registry of Aortic Dissection (IRAD). Circulation. 2003; 108 (Suppl 1): 312–7.
4. Elefteriades J.A., Lovoulos C.J., Coady M.A., Telli- des G., Kopf G.S., Rizzo J.A. Management of descending aortic dissection. Ann Thorac Surg. 1999; 67 (6): 2002–5.
5. Hagan P.G., et al. The International Registry of Acute Aortic Dissection (IRAD). JAMA. 2000; 283 (7): 897–903.
6. Durham C.A., et al. The natural history of medically managed acute type B aortic dissection. J Vasc Surg. 2015; 61 (5): 1192–9.
7. Tsai T.T., Trimarchi S., Nienaber C.A. Acute Aortic Dissection: Perspectives from the International Registry of Acute Aortic Dissection (IRAD). Eur J Vasc Endovasc Surg. 2009; 37 (2): 149–59.
8. Charilaou P., et al. Current experience with acute type b aortic dissection: Validity of the complication-specific approach in the present era. Ann Thorac Surg. 2016; 101 (3): 936–43.
9. Peterss S., et al. Changing Pathology of the Thoracic Aorta From Acute to Chronic Dissection: Literature Review and Insights. J Am Coll Cardiol. 2016; 68 (10): 1054–65.
10. Fattori R. et al. Survival after Endovascular Therapy in Patients with Type В Aortic Dissection: A Report from the International Registry of Acute Aortic Dissection (IRAD JACC Cardiovasc Interv. 2013; 6 (8): 876–82.
11. Davies R.R., et al. Yearly rupture or dissection rates for thoracic aortic aneurysms: Simple prediction based on size. Ann Thorac Surg. 2002; 73 (1): 17–28.
12. Hiratzka L.F., et al. 2010 ACCF/AHA/AATS/ACR/ ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease. J Am Coll Cardiol. 2010; 55 (14): e27–e129.
13. JCS Joint Working Group. Guidelines for diagnosis and treatment of aortic aneurysm and aortic dissection (JCS 2011): digest version. Circ J. 2013; 77 (3): 789–828.
14. Erbel R., et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J. 2014; 35 (41): 2873–926.
15. Riambau V., Böckler D., Brunkwall J., Cao P., Chiesa R., Coppi G., et al. Editor’s Choice – Management of Descending Thoracic Aorta Diseases: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2017; 53 (1): 4–52.
16. Steuer J., Eriksson M.O., Nyman R., Björck M., Wanhainen A. Early and long-term outcome after thoracic endovascular aortic repair (TEVAR) for acute complicated type B aortic dissection. Eur J Vasc Endovasc Surg. 2011; 41 (3): 318–23.
17. Pfammatter T., Steuer J., Björck M., Mayer D., Lachat M., Wanhainen A. Distinction between Acute and Chronic Type B Aortic Dissection: Is there a Subacute Phase? Eur J Vasc Endovasc Surg. 2013; 45 (6): 627–31.
18. Li Q., et al. Distal Stent Graft-Induced New Entry After TEVAR of Type B Aortic Dissection: Experience in 15 Years. Ann Thorac Surg. 2019; 107 (3): 718–24.
19. Huang C.Y., et al. Factors predictive of distal stent graft-induced new entry after hybrid arch elephant trunk repair with stainless steel-based device in aortic dissection. J Thorac Cardiovasc Surg. 2013; 146 (3): 623–30.
20. Jánosi R.A., et al. Thoracic aortic aneurysm expansion due to late distal stent graft-induced new entry. Catheter Cardiovasc Interv. 2015; 85 (2): E43–E53.
21. Boufi M., et al. Morphological Analysis of Healthy Aortic Arch. Eur J Vasc Endovasc Surg. 2017; 53 (5): 663–70.
22. Abugov S.A., Saakyan M.M., Puretskiy M.V., Polyakov R.S., Mardanyan G.V., Pirkova A.A. Morphometric analysis in patients with DeBakey type III aortic dissection based on multispiral computerized tomography imaging. Kardiologiya i serdechno-sosudistaya khirurgiya [Russian Journal of Cardiology and Cardiovascular Surgery]. 2019; 12 (4): 273–80. (in Russian)
23. Huang X., et al. Endovascular repair of Stanford B aortic dissection using two stent grafts with different sizes. J Vas Surg. 2015; 62 (1): 43–8.
24. Chen I.M., et al. Implantation sequence modifi- cation averts distal stent graft-induced new entry after endovascular repair of Stanford type B aortic dissection. J Vasc Surg. 2016; 64 (2): 281–8.
25. Masada K., et al. A novel method for prevention of stent graft-induced distal re-dissection after thoracic endovascular aortic repair for Type B aortic dissection. Interact Cardiovasc Thorac Surg. 2018; 26 (1): 91–7.
26. Li Q., et al. Risk factors for distal stent graft-induced new entry following endovascular repair of type B aortic dissection. J Thorac Dis. 2015; 7 (11): 1907–16.
27. Dong Z., et al. Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection. J Vasc Surg. 2010; 52 (6): 1450–7.
28. Nienaber C.A., et al. Randomized comparison of strategies for type B aortic dissection: The INvestigation of STEnt grafts in aortic dissection (INSTEAD) trial. Circulation. 2009; 120 (25): 2519–28.
29. Abugov S.A., et al. Endovascular repair in hybrid and staged aortic surgery. Kardiologiya i serdechno-sosudistaya khirurgiya [Russian Journal of Cardiology and Cardiovascular Surgery]. 2018; 11 (6): 38–44. (in Rus- sian)