Patient outcomes and thoracic aortic volume and morphologic changes following thoracic endovascular aortic repair in patients with complicated chronic type B aortic dissection

True and false lumen changes and patient outcomes following thoracic endovascular aortic repair (TEVAR) for patients with stable type B dissection have been described by the The Investigation of Stent Grafts in Aortic Dissection (INSTEAD) trial. However, these changes have not been described in TEVA...

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Main Authors:	Andacheh, Iden David, Donayre, Carlos, Othman, Ahmad Faidzal, Walot, Irwin, Kopchok, George, White, Rodney A.M.D.
Format:	Article
Language:	English English English
Published:	ELSEVIER 2012
Subjects:	RD Surgery RZ Other systems of medicine
Online Access:	http://irep.iium.edu.my/49990/ http://irep.iium.edu.my/49990/ http://irep.iium.edu.my/49990/ http://irep.iium.edu.my/49990/1/Patient%20outcomes%20and%20thoracic%20aortic%20volume%20and.pdf http://irep.iium.edu.my/49990/8/49990_Patient%20outcomes%20and%20thoracic_WOS.pdf http://irep.iium.edu.my/49990/9/49990_Patient%20outcomes%20and%20thoracic_SCOPUS.pdf

id	iium-49990
recordtype	eprints
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English English English
topic	RD Surgery RZ Other systems of medicine
spellingShingle	RD Surgery RZ Other systems of medicine Andacheh, Iden David Donayre, Carlos Othman, Ahmad Faidzal Walot, Irwin Kopchok, George White, Rodney A.M.D. Patient outcomes and thoracic aortic volume and morphologic changes following thoracic endovascular aortic repair in patients with complicated chronic type B aortic dissection
description	True and false lumen changes and patient outcomes following thoracic endovascular aortic repair (TEVAR) for patients with stable type B dissection have been described by the The Investigation of Stent Grafts in Aortic Dissection (INSTEAD) trial. However, these changes have not been described in TEVAR patients treated for complications of chronic dissection. Methods A single-institution study was conducted of 73 prospectively evaluated patients treated for complications of chronic type B dissection from 2002 to 2010. Spiral computed tomography reconstructions using M2S (Medical Media Systems, West Lebanon, NH) were analyzed for sequential changes in aortic volume and diameter during patient follow-up. Changes in aortic volume and diameter were tabulated as a percent change from preoperative values. Patient outcomes were determined by sequential evaluations postprocedure. Results TEVAR was successfully performed in 72 out of the 73 patients (99%). Indications for intervention were aortic enlargement (n = 62), failure of medical management (n = 7), and perforation (n = 4). The 30-day all-cause mortality rate was 14%; events were due to retrograde dissection (n = 4), cardiac-related (n = 4), and rupture (n = 2). Eleven out of the 72 patients (15%) required a secondary procedure for endoleak (n = 7) and persistent distal perfusion of the false lumen (n = 4). Mean percentage expansion of the thoracic true lumen was noted during the follow-up period: 38%, 46%, 71%, and 114% at 1-, 3-, 6-, and 12-month follow-up, respectively. Concomitant regression of the thoracic false lumen of −65%, −68%, −84%, and −84% was observed at the same intervals, respectively. Patients with an initial extension of the thoracic dissection into the infrarenal aorta (n = 46) had an increase in mean percentage change of aortic diameter and volume to 21% and 17% at 1 year, respectively. By contrast, in the patient group without infrarenal dissection (n = 14), the infrarenal aortic diameter and volume remained relatively unchanged at 3% and −0.9%, respectively, at 1-year postintervention. Conclusions TEVAR is a potential treatment option for patients experiencing complications of chronic type B dissection. During follow-up, there is a predictable expansion of the thoracic true lumen and regression of the thoracic false lumen. These findings correlate with those of the INSTEAD trial, which demonstrated false lumen regression and true lumen expansion in a cohort of patients with stable type B dissection. However, many patients with extension of thoracic dissection into the infrarenal aorta demonstrate continued aortic dilation and, on occasion, the need for secondary intervention for persistent distal perfusion. Further analysis is needed in this subgroup of patients so as to better determine potential predictors and the clinical significance of post-TEVAR infrarenal expansion. Moreover, further investigations may support a role for secondary endovascular intervention in remedying persistent infrarenal aortic expansion after TEVAR for chronic dissection.
format	Article
author	Andacheh, Iden David Donayre, Carlos Othman, Ahmad Faidzal Walot, Irwin Kopchok, George White, Rodney A.M.D.
author_facet	Andacheh, Iden David Donayre, Carlos Othman, Ahmad Faidzal Walot, Irwin Kopchok, George White, Rodney A.M.D.
author_sort	Andacheh, Iden David
title	Patient outcomes and thoracic aortic volume and morphologic changes following thoracic endovascular aortic repair in patients with complicated chronic type B aortic dissection
title_short	Patient outcomes and thoracic aortic volume and morphologic changes following thoracic endovascular aortic repair in patients with complicated chronic type B aortic dissection
title_full	Patient outcomes and thoracic aortic volume and morphologic changes following thoracic endovascular aortic repair in patients with complicated chronic type B aortic dissection
title_fullStr	Patient outcomes and thoracic aortic volume and morphologic changes following thoracic endovascular aortic repair in patients with complicated chronic type B aortic dissection
title_full_unstemmed	Patient outcomes and thoracic aortic volume and morphologic changes following thoracic endovascular aortic repair in patients with complicated chronic type B aortic dissection
title_sort	patient outcomes and thoracic aortic volume and morphologic changes following thoracic endovascular aortic repair in patients with complicated chronic type b aortic dissection
publisher	ELSEVIER
publishDate	2012
url	http://irep.iium.edu.my/49990/ http://irep.iium.edu.my/49990/ http://irep.iium.edu.my/49990/ http://irep.iium.edu.my/49990/1/Patient%20outcomes%20and%20thoracic%20aortic%20volume%20and.pdf http://irep.iium.edu.my/49990/8/49990_Patient%20outcomes%20and%20thoracic_WOS.pdf http://irep.iium.edu.my/49990/9/49990_Patient%20outcomes%20and%20thoracic_SCOPUS.pdf
first_indexed	2023-09-18T21:10:38Z
last_indexed	2023-09-18T21:10:38Z
_version_	1777411228911534080
spelling	iium-499902017-06-05T07:39:41Z http://irep.iium.edu.my/49990/ Patient outcomes and thoracic aortic volume and morphologic changes following thoracic endovascular aortic repair in patients with complicated chronic type B aortic dissection Andacheh, Iden David Donayre, Carlos Othman, Ahmad Faidzal Walot, Irwin Kopchok, George White, Rodney A.M.D. RD Surgery RZ Other systems of medicine True and false lumen changes and patient outcomes following thoracic endovascular aortic repair (TEVAR) for patients with stable type B dissection have been described by the The Investigation of Stent Grafts in Aortic Dissection (INSTEAD) trial. However, these changes have not been described in TEVAR patients treated for complications of chronic dissection. Methods A single-institution study was conducted of 73 prospectively evaluated patients treated for complications of chronic type B dissection from 2002 to 2010. Spiral computed tomography reconstructions using M2S (Medical Media Systems, West Lebanon, NH) were analyzed for sequential changes in aortic volume and diameter during patient follow-up. Changes in aortic volume and diameter were tabulated as a percent change from preoperative values. Patient outcomes were determined by sequential evaluations postprocedure. Results TEVAR was successfully performed in 72 out of the 73 patients (99%). Indications for intervention were aortic enlargement (n = 62), failure of medical management (n = 7), and perforation (n = 4). The 30-day all-cause mortality rate was 14%; events were due to retrograde dissection (n = 4), cardiac-related (n = 4), and rupture (n = 2). Eleven out of the 72 patients (15%) required a secondary procedure for endoleak (n = 7) and persistent distal perfusion of the false lumen (n = 4). Mean percentage expansion of the thoracic true lumen was noted during the follow-up period: 38%, 46%, 71%, and 114% at 1-, 3-, 6-, and 12-month follow-up, respectively. Concomitant regression of the thoracic false lumen of −65%, −68%, −84%, and −84% was observed at the same intervals, respectively. Patients with an initial extension of the thoracic dissection into the infrarenal aorta (n = 46) had an increase in mean percentage change of aortic diameter and volume to 21% and 17% at 1 year, respectively. By contrast, in the patient group without infrarenal dissection (n = 14), the infrarenal aortic diameter and volume remained relatively unchanged at 3% and −0.9%, respectively, at 1-year postintervention. Conclusions TEVAR is a potential treatment option for patients experiencing complications of chronic type B dissection. During follow-up, there is a predictable expansion of the thoracic true lumen and regression of the thoracic false lumen. These findings correlate with those of the INSTEAD trial, which demonstrated false lumen regression and true lumen expansion in a cohort of patients with stable type B dissection. However, many patients with extension of thoracic dissection into the infrarenal aorta demonstrate continued aortic dilation and, on occasion, the need for secondary intervention for persistent distal perfusion. Further analysis is needed in this subgroup of patients so as to better determine potential predictors and the clinical significance of post-TEVAR infrarenal expansion. Moreover, further investigations may support a role for secondary endovascular intervention in remedying persistent infrarenal aortic expansion after TEVAR for chronic dissection. ELSEVIER 2012-09 Article PeerReviewed application/pdf en http://irep.iium.edu.my/49990/1/Patient%20outcomes%20and%20thoracic%20aortic%20volume%20and.pdf application/pdf en http://irep.iium.edu.my/49990/8/49990_Patient%20outcomes%20and%20thoracic_WOS.pdf application/pdf en http://irep.iium.edu.my/49990/9/49990_Patient%20outcomes%20and%20thoracic_SCOPUS.pdf Andacheh, Iden David and Donayre, Carlos and Othman, Ahmad Faidzal and Walot, Irwin and Kopchok, George and White, Rodney A.M.D. (2012) Patient outcomes and thoracic aortic volume and morphologic changes following thoracic endovascular aortic repair in patients with complicated chronic type B aortic dissection. Journal of Vascular Surgery, 56 (3). pp. 644-650. ISSN 0741-5214 E-ISSN 1097-6809 http://www.sciencedirect.com/science/article/pii/S0741521412004053 10.1016/j.jvs.2012.02.050

Patient outcomes and thoracic aortic volume and morphologic changes following thoracic endovascular aortic repair in patients with complicated chronic type B aortic dissection

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