Complementary Endovascular Procedures Improve Aortic Remodeling in Progressive Chronic Aortic Dissection

Paul Revel-Mouroz1, Fatima-Zohra Mokrane1, Camille Dambrin2, Christophe Cron2, Marion Jaffro1, Bertrand Saint-Lèbes3, Charline Zadro1, Philippe Otal1 and Hervé Rousseau1*

1Department of Radiology, Hospital Rangueil, Central Hospital University of Toulouse, France
2Department of Cardiovascular Surgery, Hospital Rangueil, Central Hospital University of Toulouse, France
3Department of Vascular Surgery, Hospital Rangueil, Central Hospital University of Toulouse, France

^*Correspondance to: Hervé Rousseau 

 PDF  Full Text DOI: 10.25107/2474-1647.2756

Abstract

Objective: Residual False Lumen (FL) patency after chronic type A or type B Aortic Dissection (AD) treatment is an independent factor of poor longterm outcome. The aim of this study was to evaluate ancillary endovascular procedures in progressive AD, to improve false lumen thrombosis and aortic remodeling. Methods: Between August 2005 and December 2017, 59 ancillary endovascular procedures were performed in 35 consecutive patients for aneurysmal expansion, aortic rupture or malperfusion syndrome. Sixteen patients (45.7%) presented an initial type A AD treated by open aortic surgery, and 19 (54.3%) presented a type B AD, previously treated by TEVAR. Aortic remodeling was evaluated on the preprocedural and on the most recent computed tomography angiography followup for each patient. Results: At a median follow-up time of 60.7 months [44.4-76.8], 59 ancillary endovascular procedures were performed. At the end of the follow-up, positive remodeling was obtained in 85.7% of cases with a complete false lumen thrombosis in 9 patients (25.7%), and a diameter reduction or stability (<5 mm increase) in 21 patients (60.0%). The mean total false lumen thrombosis score before the first ancillary procedure was 0.97 (± 0.90) vs. 2.54 (± 0.98) at the end of the follow-up, p<0.0001. One patient died of a retrograde dissection, 2 days after a proximal aortic stent graft extension. Conclusion: Ancillary endovascular procedures are effective and safe to promote aortic remodeling in progressive chronic AD.

Keywords

Aortic dissection; Aortic remodeling; Thoracic endovascuar aneurysm repair; False lumen embolization; Aneurysmal expansion; TEVAR

Cite the article

Revel-Mouroz P, Mokrane F-Z, Dambrin C, Cron C, Jaffro M, Saint- Lèbes B, et al. Complementary Endovascular Procedures Improve Aortic Remodeling in Progressive Chronic Aortic Dissection. Clin Surg. 2020; 5: 2756..