Mid-term Results Of Thoracic Endovascular Aortic Repair On Zone 2 Landing For Type B Aortic Dissection
Shuhei Miura, Sr..
Teine Keijinkai Hospital, Sapporo, Japan.
OBJECTIVE We have performed zone 2 thoracic endovascular aortic repair (TEVAR) for acute and subacute type B aortic dissection (TBAD) to use the non-dissected aorta as a proximal neck. We report early and mid-term results of this strategy. METHODS Relay stent-graft (SG) was placed from zone 2 for acute TBAD as emergency and for subacute TBAD as elective TEVAR. Left subclavian artery (LSA) was preserved by a physician-modified fenestration on SG (F-TEVAR), if anatomically possible or by surgical reconstruction (D-TEVAR), if necessary. Otherwise, LSA was simply covered. RESULTS From 2013 through 2017, 14 patients (64±14 yo, 11 male) underwent zone 2 TEVAR for TBAD. False lumen (FL) was patent in 11 patients (79%), except for 3 patients (21%) with thrombosed type with ulcer like projection. Emergency TEVAR was performed for 7 patients due to malperfusion. Elective TEVAR was performed due to enlargement of FL with mean aneurysm diameter 54.4 ± 11.9 mm. Although LSA was simply covered in 5 patients on emergency TEVAR (36%), it was preserved in 9 patients (64%) through 6 F-TEVAR and 3 D-TEVAR. There were no TEVAR-related complications as stroke, spinal cord ischemia and retrograde aortic type A dissection. The early and late mortality rate was 0% in the follow-up periods of mean 17 months [0-42]. The size of the proximal descending thoracic aorta was shrinkage (pre 47.6±12.5mm vs post 41.9±10.5mm, p=0.12) and FL was thrombosed completely at the level of SG placement. The patients who underwent emergency TEVAR presented earlier aortic re-modeling as the shrinkage rate of FL (emergency 4.9% vs elective -1.8%, p=0.09) at 1 week and (emergency 56.1% vs elective 10.6%, p=0.04) at 6 months. Although stent-induced new tear below the distal edge was occurred in 1 patient (7%) and the abdominal aortic FL remains incomplete thrombosis due to the presence of re-entry in 8 patients (57%), there were not any cases which required secondary interventions. CONCLUSIONS Considering experienced stent-graft-induced new tear on the descending aorta, a proximal landing zone should be non-dissected aorta. Zone 2 TEVAR for acute and subacute TBAD might be promising to prevent for retrograde type A aortic dissection.
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