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Ann Thorac Surg. 2016 Nov;102(5):1536-1542. doi: 10.1016/j.athoracsur.2016.04.024. Epub 2016 Jun 15.

Type A Aortic Dissection After Thoracic Endovascular Aortic Repair.

Author information

1
Department of Radiology, Mie University Hospital, Mie, Japan. Electronic address: mar.adriatico0501@gmail.com.
2
Department of Radiology, Mie University Hospital, Mie, Japan.
3
Department of Cardiovascular Surgery, Mie University Hospital, Mie, Japan.
4
Department of Cardiovascular Surgery, Ise Red Cross Hospital, Mie, Japan.
5
Department of Cardiovascular Surgery, Anjo Kosei Hospital, Anjo, Aichi, Japan.
6
Department of Cardiovascular Surgery, Mie Central Medical Center, Tsu, Mie, Japan.
7
Department of Cardiovascular Surgery, Kochi Health Sciences Center, Kochi, Japan.

Abstract

BACKGROUND:

Type A aortic dissection (TAAD) is a rare complication associated with thoracic endovascular aortic repair (TEVAR). Although TAAD can result in catastrophic outcomes, the pathology of the condition has not been thoroughly clarified yet.

METHODS:

We retrospectively reviewed details from the medical records of 546 patients with diseases of the thoracic aorta (thoracic aortic aneurysm, n = 362; aortic dissection, n = 178; and fistula between the descending thoracic aorta and esophagus, n = 6) who underwent TEVAR in five hospitals from May 1997 through February 2015 to identify patients in whom TAAD developed during or after TEVAR.

RESULTS:

TEVAR-associated TAAD developed in 12 patients (2.2%). Pathologies originally treated with TEVAR were aortic dissection in 10 patients (83%) and true thoracic aortic aneurysm in 2 (17%). Type A aortic dissection developed during hospitalization in 4 patients (33%), within 1 year in 5 (42%), and more than 1 year later in 3 (25%). The entry tear was located in the ascending aorta or the aortic arch away from the edges of stent grafts in 8 patients (67%), whereas it was found just at the proximal edges of stent grafts in 4 patients (33%). Nine patients underwent ascending aortic replacement with or without concomitant aortic arch replacement, and 3 patients underwent medical management. Overall, 2 patients (17%) died during hospitalization.

CONCLUSIONS:

Type A aortic dissection can develop during TEVAR or even years after TEVAR. Careful operative procedures and follow-up should be mandatory for patients with aortic dissection as TAAD seems to occur more frequently among these patients.

[Indexed for MEDLINE]

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