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The impact of entries and exits on false lumen thrombosis and aortic remodelling

Daniel-Sebastian Dohle1, Heinz Jakob1, Robert Schucht1

  • 1Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|September 7, 2017
PubMed

Insights

The frozen elephant trunk technique effectively treats DeBakey Type I acute aortic dissection, promoting aortic remodelling. However, the number of false lumen exits negatively impacts thrombosis and remodelling, suggesting new strategies are needed.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Aortic Disease
  • Medical Imaging

Background:

  • DeBakey Type I acute aortic dissection requires combined proximal and distal thoracic aorta treatment.
  • The frozen elephant trunk (FET) technique is a key surgical approach for this condition.
  • Understanding distal aorta anatomy is crucial for predicting outcomes.

Purpose of the Study:

  • To analyze anatomical characteristics of the distal aorta.
  • To assess the impact of these characteristics on false lumen (FL) thrombosis.
  • To evaluate aortic remodelling after FET repair in Type I acute aortic dissection.

Main Methods:

  • Retrospective analysis of 63 patients with Type I acute aortic dissection treated with FET.
  • Volumetric calculation of aortic remodelling and FL thrombosis quotients at multiple segments.
  • Correlation of remodelling and thrombosis with entry tear size and FL exit number.

Main Results:

  • Positive or stable remodelling observed in 94% (Segment A), 64% (B), and 54% (C).
  • High FL thrombosis in Segment A (98%), decreasing distally (68% in B, 39% in C).
  • FL thrombosis and remodelling negatively correlated with entry size and FL exits; exits predicted negative remodelling.

Conclusions:

  • FET technique provides excellent proximal remodelling and good distal results in Type I acute aortic dissection.
  • The number of FL exits is a significant negative predictor for FL thrombosis and aortic remodelling.
  • Future endovascular strategies should focus on minimizing FL exits to improve long-term outcomes.
Abstract

Keywords:
Aortic dissectionAortic remodellingEntriesExitsFalse lumen thrombosisFrozen elephant trunk

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