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Type A Aortic Dissection After Thoracic Endovascular Aortic Repair for Type B
Kyle A McCullough1, Katherine R Hebeler2, John B Eisenga3
1Department of Cardiovascular Research, Baylor Scott & White Research Institute, Plano, Texas.
The American Journal of Cardiology
|December 11, 2024
Summary
Type B aortic dissection treated with thoracic endovascular aortic repair (TEVAR) can be followed by a new Type A aortic dissection (TAAD). Late TAAD after TEVAR for Type B dissection appears to be a distinct event.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Thoracic Surgery
Background:
- Type A aortic dissection (TAAD) is a serious cardiovascular condition.
- Thoracic endovascular aortic repair (TEVAR) is used for aortic dissections and aneurysms.
- The association between prior TEVAR for Type B dissection and subsequent TAAD is not well understood.
Purpose of the Study:
- To investigate patients who underwent TEVAR for Type B aortic dissection followed by TAAD.
- To analyze the characteristics and outcomes of TAAD occurring after TEVAR for Type B dissection.
Main Methods:
- Retrospective review of 171 consecutive patients undergoing open ascending aortic repair for TAAD over 6 years.
- Identification of patients with a history of TEVAR for Type B aortic dissection.
- Analysis of the interval between TEVAR and TAAD, and the location of the primary tear.
Main Results:
- Nine (5.2%) of 171 TAAD patients had prior TEVAR for Type B dissection.
- The mean interval from TEVAR to TAAD repair was 4.6 years.
- In most cases, the TAAD entry tear was remote from the previous endograft, suggesting a new event.
Conclusions:
- Type A aortic dissection occurring late after TEVAR for Type B dissection is uncommon.
- These late TAAD events appear to be spontaneous, new occurrences rather than complications of the prior TEVAR.
- Further research is needed to understand the specific mechanisms and risk factors for this sequence of aortic events.
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