Aortic remodeling after endovascular repair with stainless steel-based stent graft in acute and chronic type B aortic dissection

Chih Pei Ou Yang, Chiao Po Hsu, Wei Yuan Chen, I. Ming Chen, Chi Feng Weng, Chun Ku Chen, Chun Che Shih

Research output: Contribution to journalArticle

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Abstract

Objective: This study analyzes the experience of a single center using hybrid stainless steel-based endovascular stent graft repair of acute complicated and chronic type B aortic dissection aneurysm, and assesses the proximal and distal aortic morphologic changes of the midterm results. Methods: Between November 2006 and March 2011, 61 patients with type B aortic dissection underwent stainless steel-based stent graft repair and were divided into an acute complicated dissection group (AD; n = 33) and a chronic dissection aneurysm group (CD; n = 28). Serial computed tomography (CT) images were obtained to evaluate the changes of true and false lumen diameter at four levels during the postoperative period. Results: The stent graft was successfully implanted in all patients (100%), with two surgical mortalities in the AD group and low perioperative morbidity (3.6%) of stroke and paraplegia. The cumulative survival rates of the two groups were similar (77.6% and 89.0%; P =.585) in a mean follow-up period of 24.1 ± 15.6 months. Complete thrombosis of the thoracic false lumen down to the diaphragm level was achieved in 80.6% of the patients in the AD group and 88.5% in the CD group without significant difference (P =.221), but the complete regression rate of the thoracic false lumen down to the diaphragm level showed a tendency of propitious remodeling in the AD group (54.8% vs 30.8%; P =.068). During follow-up, despite the proximal changes of stented true and adjacent false lumen diameter being significantly increased and decreased, respectively, in both acute and chronic settings (P <.05), they were less prominent at the distal aorta in the CD aneurysm group. Intimomedial erosion of the distal end of the stent graft occurred in both acute (n = 6; 18.9%) and chronic (n = 10; 35.7%; P =.121) dissection settings after mean follow-up of 14.0 ± 4.8 months in the AD group and 24.8 ± 5.9 months in the CD group. Three patients with chronic dissection developed either pseudoaneurysm or true lumen compromise by expanded false lumen thrombi and required re-endografting. Conclusions: Endovascular stainless steel-based stent graft implantation with vascular bypass to gain a sufficient proximal landing zone is feasible for type B aortic dissection and has low early and midterm mortality and morbidity in both the acute and chronic phases. Although early intervention might result in more favorable aortic remodeling with a higher possibility of complete regression and lower risk of late distal erosion, longer-term follow-up still necessitates continuous careful surveillance of the entire aorta, especially the distal condition.

Original languageEnglish
Pages (from-to)1600-1610
Number of pages11
JournalJournal of Vascular Surgery
Volume55
Issue number6
DOIs
Publication statusPublished - Jun 1 2012
Externally publishedYes

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Stainless Steel
Stents
Dissection
Transplants
Diaphragm
Aneurysm
Aorta
Thrombosis
Thorax
Morbidity
Mortality
Aortic Aneurysm
Paraplegia
False Aneurysm
Postoperative Period
Blood Vessels
Survival Rate
Stroke
Tomography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Aortic remodeling after endovascular repair with stainless steel-based stent graft in acute and chronic type B aortic dissection. / Yang, Chih Pei Ou; Hsu, Chiao Po; Chen, Wei Yuan; Chen, I. Ming; Weng, Chi Feng; Chen, Chun Ku; Shih, Chun Che.

In: Journal of Vascular Surgery, Vol. 55, No. 6, 01.06.2012, p. 1600-1610.

Research output: Contribution to journalArticle

Yang, Chih Pei Ou ; Hsu, Chiao Po ; Chen, Wei Yuan ; Chen, I. Ming ; Weng, Chi Feng ; Chen, Chun Ku ; Shih, Chun Che. / Aortic remodeling after endovascular repair with stainless steel-based stent graft in acute and chronic type B aortic dissection. In: Journal of Vascular Surgery. 2012 ; Vol. 55, No. 6. pp. 1600-1610.
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AU - Hsu, Chiao Po

AU - Chen, Wei Yuan

AU - Chen, I. Ming

AU - Weng, Chi Feng

AU - Chen, Chun Ku

AU - Shih, Chun Che

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N2 - Objective: This study analyzes the experience of a single center using hybrid stainless steel-based endovascular stent graft repair of acute complicated and chronic type B aortic dissection aneurysm, and assesses the proximal and distal aortic morphologic changes of the midterm results. Methods: Between November 2006 and March 2011, 61 patients with type B aortic dissection underwent stainless steel-based stent graft repair and were divided into an acute complicated dissection group (AD; n = 33) and a chronic dissection aneurysm group (CD; n = 28). Serial computed tomography (CT) images were obtained to evaluate the changes of true and false lumen diameter at four levels during the postoperative period. Results: The stent graft was successfully implanted in all patients (100%), with two surgical mortalities in the AD group and low perioperative morbidity (3.6%) of stroke and paraplegia. The cumulative survival rates of the two groups were similar (77.6% and 89.0%; P =.585) in a mean follow-up period of 24.1 ± 15.6 months. Complete thrombosis of the thoracic false lumen down to the diaphragm level was achieved in 80.6% of the patients in the AD group and 88.5% in the CD group without significant difference (P =.221), but the complete regression rate of the thoracic false lumen down to the diaphragm level showed a tendency of propitious remodeling in the AD group (54.8% vs 30.8%; P =.068). During follow-up, despite the proximal changes of stented true and adjacent false lumen diameter being significantly increased and decreased, respectively, in both acute and chronic settings (P <.05), they were less prominent at the distal aorta in the CD aneurysm group. Intimomedial erosion of the distal end of the stent graft occurred in both acute (n = 6; 18.9%) and chronic (n = 10; 35.7%; P =.121) dissection settings after mean follow-up of 14.0 ± 4.8 months in the AD group and 24.8 ± 5.9 months in the CD group. Three patients with chronic dissection developed either pseudoaneurysm or true lumen compromise by expanded false lumen thrombi and required re-endografting. Conclusions: Endovascular stainless steel-based stent graft implantation with vascular bypass to gain a sufficient proximal landing zone is feasible for type B aortic dissection and has low early and midterm mortality and morbidity in both the acute and chronic phases. Although early intervention might result in more favorable aortic remodeling with a higher possibility of complete regression and lower risk of late distal erosion, longer-term follow-up still necessitates continuous careful surveillance of the entire aorta, especially the distal condition.

AB - Objective: This study analyzes the experience of a single center using hybrid stainless steel-based endovascular stent graft repair of acute complicated and chronic type B aortic dissection aneurysm, and assesses the proximal and distal aortic morphologic changes of the midterm results. Methods: Between November 2006 and March 2011, 61 patients with type B aortic dissection underwent stainless steel-based stent graft repair and were divided into an acute complicated dissection group (AD; n = 33) and a chronic dissection aneurysm group (CD; n = 28). Serial computed tomography (CT) images were obtained to evaluate the changes of true and false lumen diameter at four levels during the postoperative period. Results: The stent graft was successfully implanted in all patients (100%), with two surgical mortalities in the AD group and low perioperative morbidity (3.6%) of stroke and paraplegia. The cumulative survival rates of the two groups were similar (77.6% and 89.0%; P =.585) in a mean follow-up period of 24.1 ± 15.6 months. Complete thrombosis of the thoracic false lumen down to the diaphragm level was achieved in 80.6% of the patients in the AD group and 88.5% in the CD group without significant difference (P =.221), but the complete regression rate of the thoracic false lumen down to the diaphragm level showed a tendency of propitious remodeling in the AD group (54.8% vs 30.8%; P =.068). During follow-up, despite the proximal changes of stented true and adjacent false lumen diameter being significantly increased and decreased, respectively, in both acute and chronic settings (P <.05), they were less prominent at the distal aorta in the CD aneurysm group. Intimomedial erosion of the distal end of the stent graft occurred in both acute (n = 6; 18.9%) and chronic (n = 10; 35.7%; P =.121) dissection settings after mean follow-up of 14.0 ± 4.8 months in the AD group and 24.8 ± 5.9 months in the CD group. Three patients with chronic dissection developed either pseudoaneurysm or true lumen compromise by expanded false lumen thrombi and required re-endografting. Conclusions: Endovascular stainless steel-based stent graft implantation with vascular bypass to gain a sufficient proximal landing zone is feasible for type B aortic dissection and has low early and midterm mortality and morbidity in both the acute and chronic phases. Although early intervention might result in more favorable aortic remodeling with a higher possibility of complete regression and lower risk of late distal erosion, longer-term follow-up still necessitates continuous careful surveillance of the entire aorta, especially the distal condition.

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