Type A Aortic Dissection After Thoracic Endovascular Aortic Repair

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Interventional Cardiology

Background:

• Type A aortic dissection (TAAD) is a rare complication following thoracic endovascular aortic repair (TEVAR).
• The underlying pathology of TEVAR-associated TAAD remains incompletely understood.
• TAAD can lead to severe outcomes, necessitating further investigation.

Purpose of the Study:

• To investigate the incidence and characteristics of Type A aortic dissection (TAAD) developing after thoracic endovascular aortic repair (TEVAR).
• To identify risk factors and timing of TAAD occurrence in patients undergoing TEVAR.
• To inform clinical practice regarding the management and follow-up of patients treated with TEVAR.

Main Methods:

• Retrospective review of medical records from 546 patients who underwent TEVAR for thoracic aortic diseases.
• Identification of patients who developed TAAD during or after TEVAR between May 1997 and February 2015.
• Analysis of patient demographics, original pathologies, timing of TAAD, tear location, and treatment outcomes.

Main Results:

• TEVAR-associated TAAD occurred in 12 patients (2.2%), predominantly in those with prior aortic dissection (83%).
• TAAD developed during hospitalization (33%), within 1 year (42%), or over 1 year post-TEVAR (25%).
• Entry tears were located away from stent graft edges (67%) or at proximal edges (33%); 17% of patients died during hospitalization.

Conclusions:

• Type A aortic dissection is a potential complication of TEVAR, occurring both acutely and years later.
• Patients with a history of aortic dissection may be at higher risk for developing TAAD post-TEVAR.
• Meticulous surgical technique and diligent long-term follow-up are crucial for patients undergoing TEVAR, especially those with aortic dissection.