strategy of thoracic endovascular aortic repair for acute

Osaka UniversityGraduate School of Medicine

Division of Cardiovascular Surgery

Strategy of TEVAR for acute aortic Strategy of TEVAR for acute aortic dissectiondissection

Osaka University Graduate school of Medicine, Osaka University Graduate school of Medicine,

Division of Cardiovascular surgeryDivision of Cardiovascular surgery

Takuya Yoshida, Toru Kuratani, Kazuo Takuya Yoshida, Toru Kuratani, Kazuo Shimamura, Yukitoshi Shirakawa, Mugiho Shimamura, Yukitoshi Shirakawa, Mugiho Takeuchi, Keiwa Kin, Yoshiki SawaTakeuchi, Keiwa Kin, Yoshiki Sawa



Strategy of TEVAR for acute aortic dissection

・ Minimal coverage of each thoracic intimal tear (short stent graft)

・ Strict sizing (proximal 110-115%, distal -110%)



To assess the outcome of TEVAR for acute aortic dissection with minimal intimal tear closure.

Objective



Patient demographicsPatient demographics

Primary TEVAR for aortic dissection (1998 － 2009)

in acute phase (<2week) 36 cases

Age 61.5±10.3

Gender (M/F) 21 / 10

Type of dissection

Type A 7 Type B 29 complicated Type B 17 uncomplicated Type B 12



Device selectionHomemade 29Homemade + TAG 1Homemade + Excluder cuff 2TAG 2Excluder cuff 2

Average length of the stent-graft 10.3 cm



Representive case

Pre operation Post operation

Gore Aortic Extender Cuff

3.3cm



Early ResultsEarly ResultsOperative outcomeOperative outcome

Procedure success 36/36 (100%)Procedure success 36/36 (100%)

MortalityMortality 2 /36 (5.6%) (arrhythmia, intestinal

necrosis)

MorbidityMorbidityStroke 0Spinal cord ischemia 0Retrograde type A dissection 0intimal tear creation 0Iliac rupture 0

Endoleak at 1st postoperative CT 1 /36 (2.8%)



Diameter of DTADiameter of DTA

4040

3030

PrePre PostPost 6m6m 1y1y 3y3y 5y5y 7y7y

3535

Duration from TEAVRDuration from TEAVR

Max

imu

m d

iam

eter

(m

m)

Max

imu

m d

iam

eter

(m

m)

P=.0091P=.0091

TEVAR

Thoracic false lumen thrombosis 32/36 (88.9%)



follow up: average 30.1±32.0 month, max 129month

Freedom from aortic death

0

25

50

75

100

0 24 48 72 96 120

Stanford A: 100%Uncomplicated type B: 100%

Complicated type B: 88.2%

month

Freed

om

fro

m a

ort

ic d

eath

(%

)

Over all: 94.4%



eventevent POMPOM procedureprocedure

proximal ULPproximal ULP 33 TEVARTEVAR

Ascending Ao Ascending Ao ULPULP 77 TARTAR

eventevent POMPOM procedureprocedure

proximal ULPproximal ULP 55 TEVARTEVAR

distal endoleakdistal endoleak 66 TEVARTEVAR

proximal + distal proximal + distal ULPULP 1414 TAR+TEVARTAR+TEVAR

iliac aneurysmiliac aneurysm 1919 graft replacementgraft replacement

Stanford B

Stanford A

Long term results: Aortic event



Type A: 50%/5year, 50%/10year

Overall: 69.9%/5year, 69.9%/10year

Type B: 71.8%/5year, 71.8%/10year

Freed

om

fro

m

aort

ic e

ven

t (

%)

month

Freedom from aortic event



Conclusions

・・ TEVAR with minimal coverage of each TEVAR with minimal coverage of each thoracic intimal tear provided good early thoracic intimal tear provided good early phase protection.phase protection.

・・ Although further investigation is Although further investigation is necessary regarding late aortic events, necessary regarding late aortic events, this strategy may achieve the goal of false this strategy may achieve the goal of false lumen thrombosis, without incurring the lumen thrombosis, without incurring the risks of covering the whole aorta.risks of covering the whole aorta.

strategy of thoracic endovascular aortic repair for acute

Documents

strategy of tevar

acute aorticdissection

acute phase

outcome of tevar

minimal intimal tear

toru kuratani

mugiho takeuchi

yukitoshi shirakawa