The Level of Persistent False Lumen Perfusion Is Associated With Increased Aortic Size After Thoracic Endovascular Aortic Repair in Patients With Type B Aortic Dissection
Kabbani L, Nadig J, Ranjal RS, Rteil A, Linchangco R, Weaver M, Nypaver T, and Shepard A. . J Vasc Surg 2019; 70(3):e77-e78.
J Vasc Surg
Objective: Thoracic endovascular aortic repair (TEVAR) is frequently used to treat type B aortic dissection (TBAD). The goal of TEVAR is to induce false lumen thrombosis (FLT) and stabilize the aortic diameter. The success of TEVAR in TBAD is frequently impaired by the lack of a distal landing zone. This study aims to assess our experience with TEVAR to induce FLT and aortic remodeling in TBAD. Methods: Consecutive patients who underwent TEVAR for TBAD from September 2011 to September 2018 were reviewed. Reconstruction of postoperative computed tomography angiography (CTA) images was performed to determine the presence of persistent false lumen perfusion (PFLP). The level of PFLP on delayed images was reported by aortic zones based on the Society for Vascular Surgery reporting standards for TEVAR. The length of uncovered thoracic aorta (LUC) was defined as the centerline distance from the distal extent of the stent graft to the celiac artery origin. Changes in maximum thoracic aortic diameters (αT) were calculated from preoperative to most recent follow-up CTA measurements. Univariate analysis was performed to evaluate factors associated with FLT and growth of the thoracic and abdominal aorta. Results: Forty-five patients underwent TEVAR for TBAD (25 for acute presentation) and had at least one postoperative CTA scan. Average follow-up was 16 months (range, 0-61 months). Mean LUC was 37 ± 36 mm. Overall, complete thoracic FLT occurred in 45%. The thoracic aorta had PFLP through a type IB endoleak in 29% of patients, type II in 26%, and type IA in 6%. On average, the thoracic aortic diameter appeared stable (αT = 1.8 mm ± 8.62 mm). Patients with PFLP, however, had significantly more thoracic aortic expansion than those with complete FLT (αT= 4.36 mm vs −1.45 mm; P =.02). There was a significant correlation between the zone the PFLP reached and thoracic aortic diameter change (αT; P =.04; Fig). LUC was not associated with thoracic FLT. Timing of intervention (acute vs chronic) was not associated with thoracic FLT (P =.3). Conclusions: TEVAR is associated with a 45% FLT rate in patients with TBAD. PFLP was associated with increased thoracic aortic expansion, and this correlated with the zone the PFLP reached. In this study, the length of uncovered aorta was not associated with FLT. [Figure presented]