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. 2022 Apr 20:14:1-8.
doi: 10.1016/j.xjtc.2022.04.011. eCollection 2022 Aug.

Early results of bare metal extension stent for thoracoabdominal aortic dissection

Patrick R Vargo  1   2 , Christopher L Tarola  3 , Emily Durbak  4 , Chang Yoon Doh  5 , Francis J Caputo  1   6 , Christopher J Smolock  1   6 , Eric E Roselli  1   2
Affiliations

Early results of bare metal extension stent for thoracoabdominal aortic dissection

Patrick R Vargo et al. JTCVS Tech. .

Abstract

Objectives: Debakey type I and IIIb aortic dissections are complicated by extension along the full length of the aorta. Over the long term, the thoracoabdominal aorta in these patients often continues to degenerate, requiring endovascular or open repair. The purpose of this investigation is to determine the early clinical outcome on aortic remodeling using a composite thoracic stent graft and thoracoabdominal bare metal extension stenting strategy.

Methods: From April 2019 to April 2021, 73 patients with Debakey I/IIIb aortic dissection underwent endovascular stent graft repair of the descending thoracic aorta and repair of the thoracoabdominal aorta using bare metal extension stenting. Preoperative and follow-up surveillance computed tomography imaging scans were analyzed.

Results: Fifty-three (73%) patients had a Debakey I aortic dissection, and 50 (69%) patients underwent surgery during the chronic (time to surgery >30 days) dissection phase. Mortality at 30 days was 4% (3 hyperacute patients). Stroke occurred in 3 (4%), paraparesis in 2 (2.7%), and acute renal failure requiring dialysis occurred in 2 (2.7%) patients. On postoperative and follow-up computed tomography, there was a significant increase in false lumen thrombosis (P < .001). This coincided with a significant increase in true lumen fraction suggestive of positive aortic remodeling (P < .001) at the time of latest follow-up.

Conclusions: Altering the course of aortic remodeling, with placement of a dissection stent in the thoracoabdominal aorta simultaneous with descending thoracic aortic repair may promote true lumen re-expansion and false lumen thrombosis during acute and chronic dissection phases.

Keywords: CT, computed tomography; PETTICOAT; PETTICOAT, Provisional Extension to Induce Complete Attachment; TEVAR; TEVAR, thoracic endovascular aortic repair; aortic aneurysm; aortic dissection; endovascular.

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Figures

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Graphical abstract
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Computed tomography image of TEVAR with bare metal extension stent.
Figure 1
Figure 1
Freedom from reintervention and death following endovascular repair for thoracoabdominal aortic dissection with the provisional extension to induce complete attachment technique. Cumulative events (reintervention or death) are displayed in 90-day intervals. CI, Confidence interval.
Figure 2
Figure 2
True lumen area fraction. A, True lumen fraction significantly increased over follow-up. Individual observations are indicated with blue x. B through D, Partial plots of estimated marginal mean true lumen fraction (circles) and standard error (error bars) stratified by (B) dissection chronicity (red = acute, blue = subacute, and green = chronic), (C) age (red = 40 years, blue = 60 years, and green = 80 years), and (D) mean aorta area (red = 500 mm2, blue = 800 mm2, yellow = 1100 mm2, and green = 1400 mm2).
Figure 3
Figure 3
False lumen patent fraction. A, Patent fraction significantly decreased over follow-up. Individual observations are indicated with blue x. B, Estimated patent fraction by Debakey classification (red, I; blue, III). C, Estimated patent fraction by indication for surgery (red, compression; blue, size; green, growth). Error plots are shown with estimated marginal mean indicated by the circle; error bars indicate mean ± SE.
Figure 4
Figure 4
Seventy-three patients with acute, subacute, and chronic thoracoabdominal aortic dissection underwent endovascular repair with bare metal stent extension of thoracic endovascular aortic repair (TEVAR). Early outcomes demonstrated positive aortic remodeling with increase in true lumen fraction and decrease in false lumen patency fraction.
None
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References

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