Thoracic Endovascular Aortic Repair for Type B Acute Aortic Dissection Complicated by Descending Thoracic Aneurysm

G Piffaretti, P Ottavi, C Lomazzi, M Franchin, R Micheli, F Ferilli, W Dorigo, M Marrocco-Trischitta, P Castelli, S Trimarchi

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To analyse the results and review the literature about thoracic aortic endovascular repair (TEVAR) for type B acute aortic dissection (TBAAD) complicated by descending thoracic aortic aneurysm (DTA) in the hyperacute or acute phases.

METHODS: This was a multicentre, observational descriptive study. Inclusion criteria were TBAAD with a DTA of ≥50 mm, TBAAD on an already known aneurysmal descending thoracic aorta, and TBAAD presenting with an enlarged aorta with a total diameter <50 mm, but with >50% diameter increase compared with a previous computed tomography angiography (CTA) showing a non-dissected aorta with normal sizing. Primary endpoints were early and long-term survival, freedom from TEVAR and aortic related mortality (ARM), and freedom from re-intervention.

RESULTS: Twenty-two patients were included in the analysis. The mean aortic diameter was 66 ± 26 mm (range 42-130; IQR 51-64). The in hospital TEVAR related mortality was 14% (n = 3). The mean radiological follow-up was 56 ± 45 months (range 6-149; IQR 12-82), and the follow-up index 0.97 ± 0.1. All surviving patients were available for follow-up. During follow-up the cumulative mortality was 26% (n = 5) and TEVAR related mortality was 5% (n = 1). Overall the estimate of survival was 82% (95%CI: 61.5-93) at 1 year, and 64% at 5 years. Ongoing primary clinical success was 79% (re-intervention n = 4). Freedom from aortic related mortality was 86% (95%CI: 66-95) at 1 and 5 year, while freedom from re-intervention was 95% (95%CI: 75.5-95) at 1 year, and 77% (95%CI: 50-92) at 5 years.

CONCLUSIONS: In our experience, DTA is a frequent complication from the very beginning of the clinical onset of TBAAD. In this high-risk cohort, TEVAR showed satisfactory results, better than those predicted by the risk score for open repair, with favourable stability of the aortic diameter and no aortic related adverse events during follow-up.

Original languageEnglish
Pages (from-to)793-801
Number of pages9
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume53
Issue number6
DOIs
Publication statusPublished - Jun 2017

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Aneurysm
Dissection
Thorax
Thoracic Aortic Aneurysm
Mortality
Thoracic Aorta
Aorta
Survival
Observational Studies

Keywords

  • Acute Disease
  • Aged
  • Aneurysm, Dissecting/diagnostic imaging
  • Aortic Aneurysm, Thoracic/diagnostic imaging
  • Aortography/methods
  • Blood Vessel Prosthesis Implantation/adverse effects
  • Computed Tomography Angiography
  • Disease-Free Survival
  • Endovascular Procedures/adverse effects
  • Female
  • Humans
  • Italy
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome

Cite this

Thoracic Endovascular Aortic Repair for Type B Acute Aortic Dissection Complicated by Descending Thoracic Aneurysm. / Piffaretti, G; Ottavi, P; Lomazzi, C; Franchin, M; Micheli, R; Ferilli, F; Dorigo, W; Marrocco-Trischitta, M; Castelli, P; Trimarchi, S.

In: European Journal of Vascular and Endovascular Surgery, Vol. 53, No. 6, 06.2017, p. 793-801.

Research output: Contribution to journalArticle

Piffaretti, G ; Ottavi, P ; Lomazzi, C ; Franchin, M ; Micheli, R ; Ferilli, F ; Dorigo, W ; Marrocco-Trischitta, M ; Castelli, P ; Trimarchi, S. / Thoracic Endovascular Aortic Repair for Type B Acute Aortic Dissection Complicated by Descending Thoracic Aneurysm. In: European Journal of Vascular and Endovascular Surgery. 2017 ; Vol. 53, No. 6. pp. 793-801.
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abstract = "OBJECTIVES: To analyse the results and review the literature about thoracic aortic endovascular repair (TEVAR) for type B acute aortic dissection (TBAAD) complicated by descending thoracic aortic aneurysm (DTA) in the hyperacute or acute phases.METHODS: This was a multicentre, observational descriptive study. Inclusion criteria were TBAAD with a DTA of ≥50 mm, TBAAD on an already known aneurysmal descending thoracic aorta, and TBAAD presenting with an enlarged aorta with a total diameter <50 mm, but with >50{\%} diameter increase compared with a previous computed tomography angiography (CTA) showing a non-dissected aorta with normal sizing. Primary endpoints were early and long-term survival, freedom from TEVAR and aortic related mortality (ARM), and freedom from re-intervention.RESULTS: Twenty-two patients were included in the analysis. The mean aortic diameter was 66 ± 26 mm (range 42-130; IQR 51-64). The in hospital TEVAR related mortality was 14{\%} (n = 3). The mean radiological follow-up was 56 ± 45 months (range 6-149; IQR 12-82), and the follow-up index 0.97 ± 0.1. All surviving patients were available for follow-up. During follow-up the cumulative mortality was 26{\%} (n = 5) and TEVAR related mortality was 5{\%} (n = 1). Overall the estimate of survival was 82{\%} (95{\%}CI: 61.5-93) at 1 year, and 64{\%} at 5 years. Ongoing primary clinical success was 79{\%} (re-intervention n = 4). Freedom from aortic related mortality was 86{\%} (95{\%}CI: 66-95) at 1 and 5 year, while freedom from re-intervention was 95{\%} (95{\%}CI: 75.5-95) at 1 year, and 77{\%} (95{\%}CI: 50-92) at 5 years.CONCLUSIONS: In our experience, DTA is a frequent complication from the very beginning of the clinical onset of TBAAD. In this high-risk cohort, TEVAR showed satisfactory results, better than those predicted by the risk score for open repair, with favourable stability of the aortic diameter and no aortic related adverse events during follow-up.",
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T1 - Thoracic Endovascular Aortic Repair for Type B Acute Aortic Dissection Complicated by Descending Thoracic Aneurysm

AU - Piffaretti, G

AU - Ottavi, P

AU - Lomazzi, C

AU - Franchin, M

AU - Micheli, R

AU - Ferilli, F

AU - Dorigo, W

AU - Marrocco-Trischitta, M

AU - Castelli, P

AU - Trimarchi, S

N1 - Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

PY - 2017/6

Y1 - 2017/6

N2 - OBJECTIVES: To analyse the results and review the literature about thoracic aortic endovascular repair (TEVAR) for type B acute aortic dissection (TBAAD) complicated by descending thoracic aortic aneurysm (DTA) in the hyperacute or acute phases.METHODS: This was a multicentre, observational descriptive study. Inclusion criteria were TBAAD with a DTA of ≥50 mm, TBAAD on an already known aneurysmal descending thoracic aorta, and TBAAD presenting with an enlarged aorta with a total diameter <50 mm, but with >50% diameter increase compared with a previous computed tomography angiography (CTA) showing a non-dissected aorta with normal sizing. Primary endpoints were early and long-term survival, freedom from TEVAR and aortic related mortality (ARM), and freedom from re-intervention.RESULTS: Twenty-two patients were included in the analysis. The mean aortic diameter was 66 ± 26 mm (range 42-130; IQR 51-64). The in hospital TEVAR related mortality was 14% (n = 3). The mean radiological follow-up was 56 ± 45 months (range 6-149; IQR 12-82), and the follow-up index 0.97 ± 0.1. All surviving patients were available for follow-up. During follow-up the cumulative mortality was 26% (n = 5) and TEVAR related mortality was 5% (n = 1). Overall the estimate of survival was 82% (95%CI: 61.5-93) at 1 year, and 64% at 5 years. Ongoing primary clinical success was 79% (re-intervention n = 4). Freedom from aortic related mortality was 86% (95%CI: 66-95) at 1 and 5 year, while freedom from re-intervention was 95% (95%CI: 75.5-95) at 1 year, and 77% (95%CI: 50-92) at 5 years.CONCLUSIONS: In our experience, DTA is a frequent complication from the very beginning of the clinical onset of TBAAD. In this high-risk cohort, TEVAR showed satisfactory results, better than those predicted by the risk score for open repair, with favourable stability of the aortic diameter and no aortic related adverse events during follow-up.

AB - OBJECTIVES: To analyse the results and review the literature about thoracic aortic endovascular repair (TEVAR) for type B acute aortic dissection (TBAAD) complicated by descending thoracic aortic aneurysm (DTA) in the hyperacute or acute phases.METHODS: This was a multicentre, observational descriptive study. Inclusion criteria were TBAAD with a DTA of ≥50 mm, TBAAD on an already known aneurysmal descending thoracic aorta, and TBAAD presenting with an enlarged aorta with a total diameter <50 mm, but with >50% diameter increase compared with a previous computed tomography angiography (CTA) showing a non-dissected aorta with normal sizing. Primary endpoints were early and long-term survival, freedom from TEVAR and aortic related mortality (ARM), and freedom from re-intervention.RESULTS: Twenty-two patients were included in the analysis. The mean aortic diameter was 66 ± 26 mm (range 42-130; IQR 51-64). The in hospital TEVAR related mortality was 14% (n = 3). The mean radiological follow-up was 56 ± 45 months (range 6-149; IQR 12-82), and the follow-up index 0.97 ± 0.1. All surviving patients were available for follow-up. During follow-up the cumulative mortality was 26% (n = 5) and TEVAR related mortality was 5% (n = 1). Overall the estimate of survival was 82% (95%CI: 61.5-93) at 1 year, and 64% at 5 years. Ongoing primary clinical success was 79% (re-intervention n = 4). Freedom from aortic related mortality was 86% (95%CI: 66-95) at 1 and 5 year, while freedom from re-intervention was 95% (95%CI: 75.5-95) at 1 year, and 77% (95%CI: 50-92) at 5 years.CONCLUSIONS: In our experience, DTA is a frequent complication from the very beginning of the clinical onset of TBAAD. In this high-risk cohort, TEVAR showed satisfactory results, better than those predicted by the risk score for open repair, with favourable stability of the aortic diameter and no aortic related adverse events during follow-up.

KW - Acute Disease

KW - Aged

KW - Aneurysm, Dissecting/diagnostic imaging

KW - Aortic Aneurysm, Thoracic/diagnostic imaging

KW - Aortography/methods

KW - Blood Vessel Prosthesis Implantation/adverse effects

KW - Computed Tomography Angiography

KW - Disease-Free Survival

KW - Endovascular Procedures/adverse effects

KW - Female

KW - Humans

KW - Italy

KW - Kaplan-Meier Estimate

KW - Male

KW - Middle Aged

KW - Retrospective Studies

KW - Risk Factors

KW - Time Factors

KW - Treatment Outcome

U2 - 10.1016/j.ejvs.2017.02.022

DO - 10.1016/j.ejvs.2017.02.022

M3 - Article

C2 - 28341530

VL - 53

SP - 793

EP - 801

JO - European Journal of Vascular and Endovascular Surgery

JF - European Journal of Vascular and Endovascular Surgery

SN - 1078-5884

IS - 6

ER -