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. 2017 Oct;45(5):1574-1584.
doi: 10.1177/0300060517708893. Epub 2017 Jul 12.

Treatment of serious complications following endovascular aortic repair for type B thoracic aortic dissection

Zhao Liu  1 , Yepeng Zhang  1   2 , Chen Liu  1 , Dian Huang  1 , Ming Zhang  1 , Feng Ran  1 , Wei Wang  1 , Tao Shang  1 , Tong Qiao  1 , Min Zhou  1 , Changjian Liu  1
Affiliations

Treatment of serious complications following endovascular aortic repair for type B thoracic aortic dissection

Zhao Liu et al. J Int Med Res. 2017 Oct.

Abstract

Objective This study aimed to describe treatment of serious complications after primary thoracic endovascular aortic repair (TEVAR) in type B aortic dissection. Methods From June 2008 to March 2016, serious complications occurred in 58 patients without Marfan syndrome who received TEVAR for type B aortic dissection. Results Complications included endoleak, distal true lumen collapse, retrograde dissection, stroke, stent-graft (SG) migration and mistaken deployment, lower limb ischaemia, and SG fracture. Treatment included endovascular repair, surgical procedures, or conservative medication. Forty-six patients recovered from complications. Twelve patients were not cured. The median follow-up time was 29.5 months (2-61 months). The overall 30-day mortality rate was 1.7% (1/58) and the total mortality rate following secondary complications was 8.6% (5/58). The causes of death were stroke and aortic rupture. Conclusion Some treatments need to be performed after TEVAR because of severe complications. A reduction in these complications can be achieved by optimal evaluation of patients, selection of SGs, and specialized endovascular manipulation.

Keywords: Aortic dissection; complication; stent–graft; thoracic endovascular aortic repair.

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Figures

Figure 1.
Figure 1.
(a) CT shows a type B dissection that was repaired by a SG. (b) Six months after EVAR, a distal true lumen collapse was observed. (c) This collapse was treated using two SG implants. First, a smaller SG fitting the distal lumen was deployed to prevent true lumen collapse, and then a large SG fitted to the previous SG was implanted.
Figure 2.
Figure 2.
A patient with complete paralysis with previous aortic arch replacement surgery and long descending aortic coverage.
Figure 3.
Figure 3.
Bypass surgery was performed to rescue patients with an SG covering the left carotid artery.
Figure 4.
Figure 4.
Image showing a proximal bare stent that is bent outward and folded over the SG.
Figure 5.
Figure 5.
(a, b) Angiograph showing an SG in the false lumen. (c) Two other long SGs were deployed into the false lumen to connect to the distal true lumen. (d) After 30 months, the patient had severe chest pain and haemothorax. An X-ray shows that the SG is out of shape.
Figure 6.
Figure 6.
(a) Angiograph showing a fractured SG and the false lumen is expanded. (b) A new SG was deployed to repair the broken SG.
See this image and copyright information in PMC

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