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The effect of false lumen procedures during thoracic endovascular aortic repair in patients with chronic DeBakey type IIIB dissections.

Authors
 Tae-Hoon Kim  ;  Suk-Won Song  ;  Kwang-Hun Lee  ;  Min-Young Baek  ;  Kyung-Jong Yoo  ;  Bum-Koo Cho 
Citation
 JOURNAL OF VASCULAR SURGERY, Vol.68(4) : 976-984, 2018 
Journal Title
 JOURNAL OF VASCULAR SURGERY 
ISSN
 0741-5214 
Issue Date
2018
Keywords
Chronic DeBakey IIIB ; Dissection ; False lumen procedure ; TEVAR
Abstract
OBJECTIVE: Although thoracic endovascular aortic repair (TEVAR) is commonly used for chronic DeBakey type IIIB (CDIIIB) dissections, aortic remodeling outcomes after the procedure have been unsatisfactory. Persistent retrograde flow to the false lumen (FL) through re-entry tears commonly causes treatment failure. The aim of this study was to clarify the safety and effect of the FL procedure (FLP) for aortic remodeling in patients with CDIIIB dissections. METHODS: From 2012 to 2016, there were 73 patients who underwent TEVAR for CDIIIB dissections. The surgery, accompanied by the FLP, was performed in 41 patients (group A, 56%); 32 patients (group B, 44%) underwent TEVAR alone. The FLP was defined as blocking the retrograde FL flow with commercial materials. Outcomes included whole thoracic aorta FL thrombosis and diameter change in the true lumen and FL. Diameters were measured at three levels (left subclavian artery, pulmonary artery bifurcation, and celiac axis). RESULTS: No in-hospital mortality was observed. There was one case each of paraplegia and stroke postoperatively. The whole thoracic aorta FL thrombosis rate was significantly higher in group A (83% vs 56%; P = .002). Significant aortic remodeling (true lumen expansion and FL regression) was observed in both groups. In multivariable Cox regression analysis, the FLP and the number of re-entries were independent predictors for thoracic FL thrombosis (hazard ratio, 2.339 [P = .009] and 0.709 [P < .001], respectively). CONCLUSIONS: Full-coverage TEVAR with the FLP seems to be a safe endovascular treatment and promotes thoracic FL thrombosis for patients with CDIIIB dissections.
Full Text
https://www.sciencedirect.com/science/article/pii/S0741521418303987
DOI
10.1016/j.jvs.2018.01.045
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Tae Hoon(김태훈) ORCID logo https://orcid.org/0000-0003-3987-0057
Baek, Min Young(백민영)
Song, Suk Won(송석원) ORCID logo https://orcid.org/0000-0002-9850-9707
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
Lee, Kwang Hun(이광훈)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/165495
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