strategy of thoracic endovascular aortic repair for acute
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Osaka UniversityGraduate School of Medicine
Division of Cardiovascular Surgery
Strategy of TEVAR for acute aortic Strategy of TEVAR for acute aortic dissectiondissection
Osaka University Graduate school of Medicine, Osaka University Graduate school of Medicine,
Division of Cardiovascular surgeryDivision of Cardiovascular surgery
Takuya Yoshida, Toru Kuratani, Kazuo Takuya Yoshida, Toru Kuratani, Kazuo Shimamura, Yukitoshi Shirakawa, Mugiho Shimamura, Yukitoshi Shirakawa, Mugiho Takeuchi, Keiwa Kin, Yoshiki SawaTakeuchi, Keiwa Kin, Yoshiki Sawa
Osaka UniversityGraduate School of Medicine
Division of Cardiovascular Surgery
Strategy of TEVAR for acute aortic dissection
・ Minimal coverage of each thoracic intimal tear (short stent graft)
・ Strict sizing (proximal 110-115%, distal -110%)
Osaka UniversityGraduate School of Medicine
Division of Cardiovascular Surgery
To assess the outcome of TEVAR for acute aortic dissection with minimal intimal tear closure.
Objective
Osaka UniversityGraduate School of Medicine
Division of Cardiovascular Surgery
Patient demographicsPatient demographics
Primary TEVAR for aortic dissection (1998 - 2009)
in acute phase (<2week) 36 cases
Age 61.5±10.3
Gender (M/F) 21 / 10
Type of dissection
Type A 7 Type B 29 complicated Type B 17 uncomplicated Type B 12
Osaka UniversityGraduate School of Medicine
Division of Cardiovascular Surgery
Device selectionHomemade 29Homemade + TAG 1Homemade + Excluder cuff 2TAG 2Excluder cuff 2
Average length of the stent-graft 10.3 cm
Osaka UniversityGraduate School of Medicine
Division of Cardiovascular Surgery
Representive case
Pre operation Post operation
Gore Aortic Extender Cuff
3.3cm
Osaka UniversityGraduate School of Medicine
Division of Cardiovascular Surgery
Early ResultsEarly ResultsOperative outcomeOperative outcome
Procedure success 36/36 (100%)Procedure success 36/36 (100%)
MortalityMortality 2 /36 (5.6%) (arrhythmia, intestinal
necrosis)
MorbidityMorbidityStroke 0Spinal cord ischemia 0Retrograde type A dissection 0intimal tear creation 0Iliac rupture 0
Endoleak at 1st postoperative CT 1 /36 (2.8%)
Osaka UniversityGraduate School of Medicine
Division of Cardiovascular Surgery
Diameter of DTADiameter of DTA
4040
3030
PrePre PostPost 6m6m 1y1y 3y3y 5y5y 7y7y
3535
Duration from TEAVRDuration from TEAVR
Max
imu
m d
iam
eter
(m
m)
Max
imu
m d
iam
eter
(m
m)
P=.0091P=.0091
TEVAR
Thoracic false lumen thrombosis 32/36 (88.9%)
Osaka UniversityGraduate School of Medicine
Division of Cardiovascular Surgery
follow up: average 30.1±32.0 month, max 129month
Freedom from aortic death
0
25
50
75
100
0 24 48 72 96 120
Stanford A: 100%Uncomplicated type B: 100%
Complicated type B: 88.2%
month
Freed
om
fro
m a
ort
ic d
eath
(%
)
Over all: 94.4%
Osaka UniversityGraduate School of Medicine
Division of Cardiovascular Surgery
eventevent POMPOM procedureprocedure
proximal ULPproximal ULP 33 TEVARTEVAR
Ascending Ao Ascending Ao ULPULP 77 TARTAR
eventevent POMPOM procedureprocedure
proximal ULPproximal ULP 55 TEVARTEVAR
distal endoleakdistal endoleak 66 TEVARTEVAR
proximal + distal proximal + distal ULPULP 1414 TAR+TEVARTAR+TEVAR
iliac aneurysmiliac aneurysm 1919 graft replacementgraft replacement
Stanford B
Stanford A
Long term results: Aortic event
Osaka UniversityGraduate School of Medicine
Division of Cardiovascular Surgery
Type A: 50%/5year, 50%/10year
Overall: 69.9%/5year, 69.9%/10year
Type B: 71.8%/5year, 71.8%/10year
Freed
om
fro
m
aort
ic e
ven
t (
%)
month
Freedom from aortic event
Osaka UniversityGraduate School of Medicine
Division of Cardiovascular Surgery
Conclusions
・・ TEVAR with minimal coverage of each TEVAR with minimal coverage of each thoracic intimal tear provided good early thoracic intimal tear provided good early phase protection.phase protection.
・・ Although further investigation is Although further investigation is necessary regarding late aortic events, necessary regarding late aortic events, this strategy may achieve the goal of false this strategy may achieve the goal of false lumen thrombosis, without incurring the lumen thrombosis, without incurring the risks of covering the whole aorta.risks of covering the whole aorta.