Reintervention after thoracic endovascular aortic repair of complicated aortic dissection

Area of Science:

• Vascular Surgery
• Endovascular Repair
• Aortic Dissection

Background:

• Complicated aortic dissection (C-AD) presents significant management challenges.
• Thoracic endovascular aortic repair (TEVAR) has emerged as a less invasive option for C-AD.
• Predicting the need for reintervention after TEVAR in C-AD is crucial for optimizing patient outcomes.

Purpose of the Study:

• To identify predictive factors for reintervention following TEVAR in patients with C-AD.
• To evaluate the long-term efficacy and safety of TEVAR for C-AD.
• To inform clinical decision-making and improve patient selection for TEVAR in C-AD.

Main Methods:

• Retrospective institutional review of consecutive patients undergoing TEVAR for C-AD between 2000 and 2011.
• Analysis of patient demographics, primary indications for TEVAR, technical success rates, and 30-day mortality.
• Multivariate and univariate analyses to identify significant factors associated with secondary procedures.

Main Results:

• Forty-one patients underwent TEVAR for C-AD involving the descending thoracic aorta.
• Technical success was 100%, with a 30-day mortality of 5%.
• Reintervention was required in 32% of patients for various endoleaks, device migration, or aortic expansion. Significant predictors for reintervention included oversizing ≥20%, bare-spring stent in the proximal landing zone, and anticoagulant therapy. Large aortic dilatation was a risk factor, while complete false lumen thrombosis was protective.

Conclusions:

• TEVAR is a feasible treatment for C-AD, but a substantial rate of reintervention necessitates careful patient selection and monitoring.
• Excessive oversizing, proximal bare-spring stent grafts, large aortic dilatation, and anticoagulant therapy are associated with increased reintervention risk.
• Complete false lumen thrombosis at the stent graft level appears to be a protective factor against reintervention.