Society For Clinical Vascular Surgery

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The Impact of Abdominal Aortic Branch Involvement on the Abdominal Aortic Remodeling Following Thoracic Endovascular Aortic Repair for Type B Aortic Dissection
Narek Veranyan, Eric Kuo, Sung Ham, Fred Weaver, Vincent Rowe, Fernando Fleischman, Michael Bowdish, Sukgu Han.
Keck Hospital of University of South California, Los Angeles, CA, USA.

Factors influencing abdominal aortic remodeling following thoracic endovascular aortic repair for aortic dissections (TEVAR-AD) remain unknown. The objective of this study is to determine the impact of abdominal aortic branch involvement by dissection on abdominal aortic remodeling following TEVAR-AD.
Review of all consecutive patients who underwent TEVAR for type B aortic dissections at a regional aortic center was performed. Computed tomography angiogram (CTA) images were reviewed to identify dissection involvement of the celiac, superior and inferior mesenteric, bilateral renal and common iliac arteries at baseline. Follow up CTA images were reviewed to identify the degree of false lumen thrombosis(FLT) in the stented thoracic aorta, as well as the unstented thoracic and abdominal aortic segments. Rates of FLT were correlated with the number abdominal branches involved in dissection, as well as the individual branch perfusion pattern.
From December 2006 to June 2016, 108 patients underwent TEVAR-AD, 62 of whom had pre and post-operative CTA available for analysis. The mean follow up was 424 days. Indications for TEVAR-AD were persistent pain (40%), malperfusion (20%), rupture (6%), aneurysmal degeneration (26%).uncontrolled hypertension (8%). Thirty-six (58%) were treated during the acute phase (<14 days). All patients had dissection extending to the abdominal aorta. Overall, FLT was seen in 53%, 29%, and 14% of the stented thoracic aorta, unstented thoracic, and abdominal aortic segments respectively. Patients who developed abdominal aortic FLT following TEVAR-AD presented with fewer number of abdominal aortic branches involved in dissections. No patient developed abdominal aortic FLT during follow up if either the celiac or superior mesenteric artery was involved by the dissection.
Abdominal aortic remodeling, as indicated by complete false lumen thrombosis, after TEVAR-AD is rare. Specifically, visceral artery involvement portended complete lack of abdominal FLT following TEVAR-AD.

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