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. 2022 Jul 17;11(14):4154.
doi: 10.3390/jcm11144154.

Thoracic Endovascular Aortic Repair (TEVAR) First in Patients with Lower Limb Ischemia in Complicated Type B Aortic Dissection: Clinical Outcome and Morphology

Katrin Meisenbacher  1 , Matthias Hagedorn  1 , Denis Skrypnik  1 , Samuel Kilian  2 , Dittmar Böckler  1 , Moritz S Bischoff  1 , Andreas S Peters  1
Affiliations

Thoracic Endovascular Aortic Repair (TEVAR) First in Patients with Lower Limb Ischemia in Complicated Type B Aortic Dissection: Clinical Outcome and Morphology

Katrin Meisenbacher et al. J Clin Med. .

Abstract

Acute Type B aortic dissection (TBAD) can cause organ malperfusion, e.g., lower limb ischemia (LLI). Thoracic endovascular aortic repair (TEVAR) represents the standard treatment for complicated TBAD; however, with respect to LLI, data is scant. The aim of this study was to investigate clinical and morphological outcomes in patients with complicated TBAD and LLI managed with a "TEVAR-first" policy. Between March 1997 and December 2021, 731 TEVAR-procedures were performed, including 106 TBAD-cases. Cases with TBAD + LLI were included in this retrospective analysis. Study endpoints were morphological/clinical success of TEVAR, regarding aortic and extremity-related outcome, including extremity-related adjunct procedures (erAP) during a median FU of 28.68 months. A total of 20/106 TBAD-cases (18.8%, 32-82 years, 7 women) presented with acute LLI (12/20 Rutherford class IIb/III). In 15/20 cases, true lumen-collapse (TLC) was present below the aortic bifurcation. In 16/20 cases, TEVAR alone resolved LLI. In the remaining four cases, erAP was necessary. A morphological analysis showed a relation between lower starting point and lesser extent of TLC and TEVAR success. No extremity-related reinterventions and only one major amputation was needed. The data strongly suggest that aTEVAR-first-strategy for treating TBAD with LLI is reasonable. Morphological parameters might be of importance to anticipate the failure of TEVAR alone.

Keywords: TEVAR; aortic dissection; complicated type B dissection; extremity malperfusion; lower limb ischemia; malperfusion; thoracic endovascular repair.

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Conflict of interest statement

D.B. is a consultant for W.L. Gore & Associates, Arsenal Medical, Brainlab AG, Cook Medical, Endologix LLC, Medtronic GmbH, and a member of the advisory board of Brainlab AG, Cook Medical, Endologix LLC, Medtronic GmbH, W.L. Gore & Associates, and Siemens AG and has received speaker honoraria and educational and research grants from W.L. Gore & Associates, Cook Medical, Endologix LLC, Medtronic GmbH, Siemens Ag, and Getinge GmbH. M.S.B. has received speaker honoraria from W.L. Gore & Associates. A.S.P. has received speaker honoraria from Medtronic GmbH and Johnson & Johnson Medical GmbH and a travel grant from the 41st Charing Cross Symposium 2019, 15–18 April 2019. All other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Extended aortic zones; based on Fillinger et al. [12]. CT: celiac trunk; SMA: superior mesenteric artery; RA: renal artery; CIA: common iliac artery; EIA: external iliac artery; IIA: internal iliac artery.
Figure 2
Figure 2
Flowchart of patient selection.
Figure 3
Figure 3
Morphological presentation before TEVAR (A), after TEVAR with respect to intraoperative angiography (B) and after treatment, including a potential extremity related adjunct procedure (C).
Figure 3
Figure 3
Morphological presentation before TEVAR (A), after TEVAR with respect to intraoperative angiography (B) and after treatment, including a potential extremity related adjunct procedure (C).
Figure 4
Figure 4
Explanatory caption of Figure 3A–C as well as Figure 5.
Figure 5
Figure 5
Secondary rearrangement according to morphological distribution patterns, comparing TEVAR alone with TEVAR + extremity related adjunct procedure (erAP) cases.
Figure 6
Figure 6
Cumulative frequencies of true lumen collapse, comparing cases treated with TEVAR alone with TEVAR + erAP cases.
Figure 7
Figure 7
Boxplots representing the starting point (A) and the extent of true lumen collapse (TLC) (B) in cases treated with TEVAR alone versus TEVAR + erAP cases.
See this image and copyright information in PMC

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