Intimo-Intimal Intussusception during Endovascular Repair of Type B Aortic Dissection

Area of Science:

• Cardiovascular Surgery
• Interventional Radiology
• Medical Imaging

Background:

• Stent graft induced aortic intimo-intimal intussusception (SAoII) is a rare but potentially catastrophic complication during thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD).
• Accurate identification of SAoII's imaging features is essential for timely and effective management to prevent adverse outcomes.

Purpose of the Study:

• To report reliable imaging features of SAoII.
• To improve the avoidance and management of this complication during TEVAR for TBAD.

Main Methods:

• Retrospective, multicentre observational analysis of patients undergoing TEVAR for TBAD from January 2014 to December 2022.
• Definition of SAoII as intra-procedural disruption of the aortic intima due to TEVAR.
• Summarization of imaging features and management strategies for SAoII.

Main Results:

• SAoII was observed in 20 out of 1,643 patients (1.2%) undergoing TEVAR for TBAD.
• Key imaging features included floating endograft (85%), intussusception of the intima layer (65%), and displacement of intima/wire/delivery system (40%).
• SAoII occurred most frequently after stent graft deployment (60%). All patients were successfully managed with additional stent grafts, with no aorta-related deaths during a median follow-up of 51.5 months.

Conclusions:

• SAoII is a rare, potentially fatal iatrogenic complication of TEVAR for TBAD.
• Endovascular interventions, guided by timely and accurate identification of imaging features, are effective for managing SAoII.
• Recognizing specific imaging findings is critical for successful treatment of this complication.