Intraoperative Stent-Graft-Induced Aortic Intimal Intussusception During TEVAR for Type B Aortic Dissection

Area of Science:

• Cardiovascular Surgery
• Endovascular Interventions
• Aortic Dissection Management

Background:

• Aortic intimal intussusception is a known complication of aortic dissection.
• Intraoperative stent-graft (SG)-induced aortic intimal intussusception (ISAII) is a rare but potentially fatal complication of thoracic endovascular aortic repair (TEVAR).
• Previous reports of ISAII related to TEVAR for Stanford type B aortic dissection are limited.

Purpose of the Study:

• To report a series of endovascular repair cases for ISAII.
• To define ISAII, outline diagnostic steps, and describe resolution techniques.
• To raise awareness of ISAII to improve physician management during TEVAR.

Main Methods:

• ISAII defined as intraoperative disruption of the distal intimal flap during endovascular treatment.
• Analysis of 14 patients who underwent endovascular repair for ISAII from January 2014 to June 2020.
• Classification of ISAII lesions into three types based on location relative to the stent graft and aortic branches.

Main Results:

• ISAII incidence was 1.28% (14/1096) in patients undergoing TEVAR for Stanford type B aortic dissection.
• Endovascular repair was effective for all ISAII types.
• Mean follow-up of 27.36 months showed stable ISAII lesions and patent aortic branches, SGs, and bare stents.

Conclusions:

• Accurate diagnosis and prompt management are crucial for this devastating intraoperative complication.
• Endovascular repair is an effective and durable treatment for ISAII.
• Increased awareness and adapted techniques can help overcome ISAII during TEVAR.