Author + information
- Received May 12, 2015
- Revision received October 9, 2015
- Accepted October 20, 2015
- Published online January 25, 2016.
- Fabrizio Fanelli, MD∗∗ (, )
- Alessandro Cannavale, MD∗,
- Gerard J. O’Sullivan, MD†,
- Marianna Gazzetti, MD, PhD‡,
- Carlo Cirelli, MD∗,
- Pierleone Lucatelli, MD∗,
- Mariangela Santoni, MD∗ and
- Carlo Catalano, MD∗
- ∗Department of Radiological Sciences, University of Rome “Sapienza,” Rome, Italy
- †Department of Interventional Radiology, University College Hospital Galway, Galway, Ireland
- ‡Department of Vascular Surgery, “Sapienza” University of Rome, Rome, Italy
- ↵∗Reprint requests and correspondence:
Dr. Fabrizio Fanelli, University of Rome “Sapienza,” Department of Radiological Sciences, 324 Viale Regina Elena, 00161 Rome, Italy.
Objectives The aim of this study was to assess factors influencing the clinical outcome and morphological changes of acute and chronic type B aortic dissection after thoracic endovascular aortic repair (TEVAR).
Background Aortic remodeling after TEVAR may be associated with clinical outcome, complications, and endoleak development.
Methods Sixty cases of TEVAR for complicated type B acute aortic dissection (AAD) (n = 29) and chronic aortic dissection (CAD) (n = 31) with a minimum follow-up of 3 years were retrospectively reviewed. Using computed tomography images, we assessed true lumen, false lumen, and total aortic short-axis diameters. Six procedural factors were analyzed in relation to aortic remodeling and other outcomes. Analysis of variance was used to compare short-axis, false lumen, and true lumen diameters during the follow-up period. Univariate and multivariate analyses were used to assess the relationship between procedural factors and multiple outcomes.
Results A total of 100 stent grafts were implanted in 60 consecutive patients with acute aortic dissection (AAD) and CAD. Aortic remodeling consisting of false lumen thrombosis and shrinkage was more prominent in AAD than in CAD, especially within the first 18 months. Of note, the entire aortic diameter increased significantly cephalad to the stent graft in AAD. Only in the AAD group there was increased aortic remodeling related to post-dilation of the stent graft. Type I and II endoleaks occurred in 17 patients (28%); in AAD, embolization of the left subclavian artery after stent graft deployment was significantly associated with a lower risk of endoleak development, but this was not evident in CAD.
Conclusions Aortic remodeling and clinical outcome after TEVAR can be influenced by procedural techniques (post-dilation and embolization of the left subclavian artery in patients with acute but not chronic aortic dissection).
Dr. O’Sullivan is a consultant to and on the Scientific Advisory Board of Bard; and has received honoraria for lecturing from Boston Scientific, Medtronic, Cook Medical, Straub Medical, Optimed, and Marvao Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 12, 2015.
- Revision received October 9, 2015.
- Accepted October 20, 2015.
- American College of Cardiology Foundation