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Tevar for Complicated Thoracoabdominal Aortic Dissections with Multilayer Stents
Victor Costache, Andreea Costache, Crina Solomon, Anca Chitic, Cristian Bucurenciu, Gabriela Candea
University Lucian Blaga Sibiu, Sibiu, Romania

Background: To report a single-center series of patients with type B aortic dissection (TBAD) treated endovascular (TEVAR) with the Multilayer Flow Modulator (MFM). Primary endpoints were freedom from rupture, freedom from dissection-related death, overall mortality and freedom from reintervention. Secondary outcomes included technical success, adverse events, and aortic remodelling.Methods: 23 patients with complicated thoracoabdominal aortic dissections were treated with new generation Multilayer Flow Modulator Stents since April 2014 with a maximum follow-up of 36 months. Clinical and imaging data were collected preoperatively, direct postoperatively and annually to 36 months for analysis using computational fluid dynamics (CFD). Each CT scan was used for morphological CFD analysis performed with MIMICS (Materialise, Belgium) while flow and shear stress CFD were performed with ANSYS (Ansys Inc., Southpointe USA). Aortic remodelling was measured for each patient and at each follow up, by calculating False Lumen Index (FLI), true and false lumen volumes.Results: With a maximum follow-up of 36 months, initial technical success was 100%, freedom from ruptures or aortic-related deaths was 100%, 95.7% for freedom from overall mortality, and 91.3% for freedom from reintervention. A total of 144 arterial branches completely covered by the multilayer stents during endovascular treatment remained patent. Morphologic analysis of the aorta dissection showed progressive true lumen volume increase (75.9%, p &lt 001) with concomitant false lumen volume decrease (42.8% p lt 001); the CFD flow analysis showed increased laminar flow. Positive aortic remodelling was demonstrated by an increase in true lumen volume and a decrease in false lumen volume and false lumen index Conclusion: In the current study, the MFM stents for complicated thoracoabdominal dissections provides a safe and feasible treatment option with high technical success, low mortality and active aortic remodeling. Further studies should elucidate the long-term safety of this promising technology and the effectiveness in a larger patient populations.


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