Importance of Early Aortic Surveillance after Endovascular Treatment of Type B Aortic Dissection with Malperfusion Syndrome

• Published in: Annals of vascular surgery Vol. 36; pp. 106 - 111
• Main Authors: Hahtapornsawan, Suteekhanit, Bisdas, Theodosios, Torsello, Giovanni, Criado, Frank J, Austermann, Martin, Donas, Konstantinos P
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.10.2016
• Subjects: Adult; Aged; Aneurysm, Dissecting - diagnostic imaging; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - physiopathology; Aneurysm, Dissecting - surgery; Aortic Aneurysm - diagnostic imaging; Aortic Aneurysm - mortality; Aortic Aneurysm - physiopathology; Aortic Aneurysm - surgery; Aortography - methods; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - mortality; Computed Tomography Angiography; Disease-Free Survival; Early Diagnosis; Endoleak - diagnostic imaging; Endoleak - etiology; Endoleak - surgery; Endovascular Procedures - adverse effects; Endovascular Procedures - mortality; Female; Germany; Humans; Ischemia - diagnostic imaging; Ischemia - mortality; Ischemia - physiopathology; Ischemia - surgery; Kaplan-Meier Estimate; Male; Medical Records; Middle Aged; Predictive Value of Tests; Regional Blood Flow; Reoperation; Retrospective Studies; Risk Factors; Surgery; Time Factors; Treatment Outcome
• ISSN: 0890-5096; 1615-5947
• DOI: 10.1016/j.avsg.2016.03.011

Background The aim of the study was to assess the incidence and timing of adverse events and complications occurring after endovascular treatment of type B aortic dissection (TBAD) complicated with malperfusion syndrome (MPS). Methods Twenty-eight patients with TBAD and MPS treated endovascularly at our center from January 2006 to January 2015 were evaluated through a retrospective scrutiny of the medical records. The primary end point of the study was aorta-related reintervention. The secondary end point was all-cause mortality. Results The MPS included the mesenteric and renal arteries in 14 (50%) and 21 (75%) patients, respectively, the lower extremities in 14 (50%) patients and the spinal cord in 3 (10.7%). The 1-year and 5-year freedom of reintervention rate were 86.2% and 74.7%, respectively. The median time to reintervention was 4.5 months. The main reason for reintervention was type I proximal endoleak which was treated by proximal endograft extensions and appropriate arch-branch management. The perioperative mortality was 14.3% (4 of 28). The mean follow-up was 61.7 months (range, 2–96 months). The short-term and long-term survivals were 82.1% at 1 and 5 years, respectively. Conclusions The results suggest that closer follow-up and imaging surveillance of the aorta are warranted after thoracic endovascular aortic repair treatment of TBAD and MPS. And especially so during the first 6 months to enable timely detection and correction of potential complications.