Mechanisms of and treatment strategies for dsine after TEVAR for acute and chronic type B aortic dissection- insights from EuREC.
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1 Mechanisms of and treatment strategies for dsine after TEVAR for acute and chronic type B aortic dissection- insights from EuREC Martin Czerny
2 Content EuREC Contributors dsine Mechanisms Results Summary
3 EuREC Independent (no industry funding) scientific platform to collect rare unusual complications of TEVAR Founded by interventional cardiologist, interventional radiologist, vascular surgeon, cardiothoracic surgeon estimate the incidence understand pathologic mechanisms and identify patient and procedurerelated factors characterize current management and outcomes of patients
4 EuREC Previous projects Retrograde type A aortic dissection Circulation 2009 Symptomatic spinal cord injury JEVT 2012 Aorto-esophageal fistulation EJCTS 2014 Aorto-bronchial fistulation EJCTS 2015
5 Content EuREC Contributors dsine Mechanisms Results Summary
6 Contributing centers Berne, Budapest, Essen, Freiburg, Heidelberg, Innsbruck, Cologne, Milano, Munich, Nieuwegein, Tübingen, Toulouse
7 Content EuREC Contributors dsine Mechanisms Results Summary
8 Methods Total case load (type B) 1417 TEVAR procedures (12 centers) 66 patients indentified (4.3%)
9 Methods
10 Siena diameter correction
11 Content EuREC Contributors dsine Mechanisms Results Summary
12 Functional imaging
13 Functional imaging
14 Functional imaging
15 Functional imaging
16 Functional imaging
17 Content EuREC Contributors dsine Mechanisms Results Summary
18 Patients Characteristics Baseline patient characteristics n=66 Demographics Male, No. (%) 43 (65) Age, mean ± SD, y 57.7 ± 13,5 Medical history Hypertension, No (%) 59 (89,4) Coronary artery disease, No (%) 10 (15,2) Previous CABG, No (%) 3 (4,5) Previous aortic surgery/ intervention, No (%) 15 (22,7) Ascending 13 (19,7) Arch 4 (6,1) Descending 2 (3,0) Abdominal 0(0)
19 Aortic Characteristics Aortic characteristics n=66 Underlying aortic disease Acute type B dissection (<14 d), No. (%) 31 (47,0) Chronic type B dissection (> 14d), No. (%) 30 (45,5) IMH, No. (%) 2 (3,0) Other, No. (%) Acute type A dissection 3 (4,5) Chronic type B dissection Days between acute event and TEVAR, mean ± SD 485±738 Presumed etiology Atherosclerotic/ hypertensive, No. (%) 55 (83,3) Degenerative, No. (%) 7 (10,6) Connective tissue disease, No. (%) 4 (6,1) Traumatic, No. (%) Other, No. (%) 2 (3,0) 1 (1,5)
20 Aortic Characteristics Aortic characteristics n=66 Extension of dissection Descending Iliacs, No. (%) 24 (36,4) Arch Iliacs, No. (%) 19 (28,8) Descending Abdominal, No. (%) 12 (18,2) Arch Abdominal, No. (%) 8 (12,1)
21 Treatment Treatment n=66 Type of procedure Elective, No. (%) 39 (59,1) Emergency, No. (%) 25 (37,9) N/A, No. (%) 2 (3,0) Type of prosthesis Medtronic, No. (%) Gore, No. (%) Bolton Medical, No. (%) Thoraflex hybrid, No. (%) N/A, No. (%) 31 (47,0) 16 (24,2) 13 (19,7) 4 (6,1) 2 (3,0) Number of prosthesis n=1, No. (%) 54 (81,8) n=2, No. (%) 8 (12,1) n=3, No. (%) 4 (6,1)
22 Treatment Treatment n=66 Landing zone Criado zone 2, No. (%) 42 (63,6) Criado zone 3, No. (%) 24 (36,4) Intended or accidental overstenting of arch vessels Yes, left subclavian artery, No. (%) No, No. (%) 31 (47,0) 35 (53,0) Supraaortic transpositions No, No. (%) 48 (72,7) Yes, No. (%) 18 (27,3) Distal part of stent-graft crossing thoracoabdominal transition, No. (%) Distal extension with bare stent, No. (%) 9 (13,6) 1 (1,5)
23 Results, Initial completion CT after TEVAR Endoleak No. (%) Results n=66 14 (21,2) False lumen status at stent-graft level thrombosed, No. (%) 39 (59,1) partially thrombosed, No. (%) 23 (34,8) patent, No. (%) 3 (4,5) N/A, No. (%) 1 (1,5) False lumen status at TA transition thrombosed, No. (%) partially thrombosed, No. (%) patent, No. (%) N/A, No. (%) 14 (21,2) 25 (37,9) 25 (37,9) 2 (3,0)
24 Results Results, Distal Stent-graft induced new entry (dsine) Occurrence of dsine, days since TEVAR mean ± SD Endoleak No. (%) n=66 938± (60,6) False lumen status at stent-graft level thrombosed, No. (%) 23 (34,8) partially thrombosed, No. (%) 32 (48,5) patent, No. (%) 9 (13,6) N/A, No. (%) 2 (3,0) False lumen status at TA transition thrombosed, No. (%) partially thrombosed, No. (%) patent, No. (%) N/A, No. (%) 13 (19,7) 23 (34,8) 27 (40,9) 3 (4,5)
25 Results Management and follow- up n=66 Management Conservative 21 (31,8) TEVAR extension 41 (62,1) Classical surgery N/A, No. (%) 3 (4,5) 1 (1,5) FUP, days after diagnosis of dsine mean ± SD 1397± 1150 Recurrence of dsine No, No. (%) Yes, No. (%) Not treated, No. (%) 41 (62,1) 4 (6,1) 21 (31,8)
26 Content EuREC Contributors dsine Mechanisms Results Summary
27 Conclusions dsine after TEVAR is not rare in both acute and chronic scenarios The timepoint of occurence is not predictable A mismatch between true lumen size and stent-graft diameters have an impact Occurs with low and high radial force devices Distal TEVAR extension and classical surgery are options for treatment Life-long surveillance of patients after TEVAR for type B remains mandatory
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