Jianfang Luo MD Ph.D

Dept. of Cardiology

Guangdong General Hospital

Guangzhou P.R.China

Perioperative aortic dissection rupture

after endovascular stent graft placement

for treatment of type B dissection

Range 1.8-6.5%

Risk factors of aortic rupture for TEVAR

• The status of disease

• The condition of the aortic wall

• The radial force and the “springback” force

• Design of the stent

• ……

Consecutive 563 type B AD patients who received TEVAR, 2004 to Dec. 2011 (175 variables)

• 12 (2.1%) patients died after TEVAR

• 2/3 result by aortic rupture • 1/2 aortic rupture caused by rAAD

Patients characteristics

Details of 12 patients suffered death after TEVAR

Age (years) Sex Total number of devices implanted Device used Extra procedure Death time Death reason

69 M 3 Talent 9 days rAAD rupture (suspicious)

54 M 1 Hercules Supraaortic branches

bypass/balloon dilation

30 days Sever infection after intestinal ischemia/MODS

58 F 1 Talent Supraaortic branches bypass

2 hours AD rupture

53 M 1 Hercules 4 hours AD ruptur

77 M 1 Talent 14 days Sever lung infection /acute renal failure /MODS

42 M 1 Hercules Try to reconstruct the SMA but

failure

1 day Limbs and intestinal infarction/MODS§

70 M 1 Hercules 8 hours AD rupture

46 M 1 Talent 3 days Renal and intestinal schemia/MODS

40 M 1 Talent 3 days AD rupture

69 M 1 Talent Supraaortic branches bypass

10 days rAAD rupture

57 M 3 Hercules 4 days rAAD rupture (suspicious)

56 F 1 Talent

Pull back the stent by balloon

dilation

2 days rAAD rupture

Characteristics of TEVAR

Characteristics of the vascular situation of AD

Conclusion

Aortic rupture serves as one of the most

important role of perioperative death

Risk factors of aortic rupture after TEVAR may

be:

Severe AD need multi-stent implantation

Ascending aorta diameter ≥ 4cm

Aortic dissection involve the concavity

The proximal bare spring stent may have a

higher probability of aortic rupture

Thanks!