Endovascular therapy for Ischemic versus Nonischemic complicated acute type B aortic dissection (catbad).
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1 Endovascular therapy for Ischemic versus Nonischemic complicated acute type B aortic dissection (catbad). AS. Eleshra, MD 1, T. Kölbel, MD, PhD 1, F. Rohlffs, MD 1, N. Tsilimparis, MD, PhD 1,2 Ahmed Eleshra Aortic fellow, German Aortic Center, Department of Vascular Medicine University Heart Center, Hamburg
2 Disclosure I do not have any disclosure or conflict of interest Ahmed Eleshra
3 Endovascular repair for Type B Aortic dissection
4
5 Patients Retrospective analysis of TEVAR database (November 2010 and December 2017). Aortic dissection was defined as acute within 14 days of the onset of acute symptoms Acute Type B aortic dissection. Patients were grouped in two cohorts; Non-ischemic catbad and Ischemic catbad. o o o o Aneurysmal dilatation False lumen rupture unrelenting pain uncontrolled hypertension
6 Left kidney malperfusion Preoperative CTA Rt. Kidney, mesentric and extremity malperfusion Ruptured FL
7 Planning of procedure Branch vessel malperfusion I. Reperfusion after TEVAR II. Adjunctive branch vessel stenting TEVAR Landing zones FL occlusion with candy plug III. Intimal flap fenestration
8 Non Ischemic catbad Pre operative CTA with acute type B AD with progressive dilatation and intractable pain Post-oprtative 6 months follow up CTA after TEVAR
9 Malperfusion of both renal arteries
10 Results
11 Patients Demographics and characteristics Variables Non-ischemic group n=39 (%) Ischemic group n=25 (%) P value Age ( Mean±SD) 66.33± ± Males 28 (71) 21 (84) Comorbidities CAD HTN DM Stroke CABG COPD Stroke Renal insufficiency Smoking CTD PAD 4 (10) 29 (74) 10 (39) 2 (5) 1 (2) 2 (5) 2 (5) 3 (8) 6 (15) 1 (2) 1 (2) 4 (16) 17 (68) 0 (0) 2 (8) 1 (4) 2 (8) 2 (8) 8 (32) 4 (16) 1 (4) 2 (8) Previous Aortic repair Ascending aorta open Arch, descending open AAA open EVAR 4 (10) 3 (8) 1 (2) 0 (0) 1 (4) 2 (8) 1 (4) 1 (4)
12 TEVAR DATA Variables group Nonischemic Ischemic- Group n=25 (%) P Value Total Group n=64 (%) Branch vessel stenting n=39 (%) < 24 hours 21 (54) 19 (76) (62.5) Time to 7.5± ± ± patients 20 stents intervention (Mean±SD) Aortic endograft 11 Bare metal stent 9 covered stent Number(Mean±SD) Proximal Landing Zone ± ± ±0.6 1 (2) 0 (0) 1 (1.5) LNA 8 RNA 5 SMA1 Iliac 4 Zone 2 16 (41) 15 (60) 31 (48.4) Zone 3 22 (56) 8 (32) 30 (46.9) Zone 4 0 (0) 2 (8) 2 (3)
13 Early and late outcome Variables Group Group II P value I N=39 (%) N=25 (%) Non Ischemic group Ischemic group 30 day Death 2 (5) 4 (16) Complications Stroke Paraplegia Respiratory Renal insufficiency Wound infection 1 (2) 2 (5) 1 (2) 1 (2) 3 (8) 0 (0) 0 (0) 2 (8) 2 (8) 1 (4) Early endoleak Early retrograde flow 2(5) 2 (5) 1(4) 0 (0) ICU stay in days (SD) 4.8±9.4 2± Post-operative hospital stay in 7.4± ± days (SD) 2 Late outcome Endoleak Retrograde flow Reintervention 3 (8) 2 (5) 5 (12) 1 (4) 0 (0) 4 (16) o o Death Pulmonary complication visceral ischemia Late endoleak Persistent retrograde flow in 2 patients Type II endoleak in 3 patients with sac enlargement in one Re-intervention Candy plug for retrograde flow in 2 patients Embolization of sac in for type II endoleak in one case LCCA-LSA bypass for arm claudication Ascending aorta and partial arch replacement for RTAAD o o Death 2 cardiac arrest (renal, mesenteric) 2 SIRS (mesenteric). Late endoleak Type I a endoleak Re-intervention LCCA-LSA and zone 2 TEVAR for type I a endoleak distal TEVAR in order to expand the true lumen at the level of right renal artery for kidney malperfusion LCCA-LSA for arm claudication in 2 patients
14 Final results Ruptured FL after TEVAR Correction of malperfusion
15 Branch vessel stenting in malperfusion Ruptured Acute Type B AD
16 Branch vessel stenting in malperfusion
17 Ruptured Acute Type B AD 16 % mortality 8% major complication 40% reintervention Our Data 1/8 (12%) mortality 1/8 (12%) major complication No reintervention
18 Home message TEVAR is an effective and safe method for treating catbad. Visceral direct reperfusion after TEVAR through branch vessel stenting is crucial in achieving good outcome Results suggested no statistically significant difference at the outcome of Ischemic versus Nonischemic catbad.
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