perioperative aortic dissection rupture after endovascular...
TRANSCRIPT
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
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