Endovascular treatment outcomes of chronic thoracoabdominal aortic dissection_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HE Mengwei , QU jin , HUO Weixue , ZHANG Heng , LU Ye , TIAN Wen , ZENG Zhaoxiang ,  FENG Rui

Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai 200433, P. R. China;

Corresponding author：

FENG Rui, Email: rui.feng@shgh.cn

Keywords：

thoracoabdominal aortic dissection; endovascular treatment; fenestrated stent graft; branched stent

DOI：

10.7507/1007-9424.202405040

Video：

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Objective To evaluate the feasibility, safety and efficacy of endovascular treatment for chronic thoracoabdominal aortic dissection. Methods The patients with chronic thoracoabdominal aortic dissection who underwent total endovascular treatment at Shanghai City First People’s Hospital between December 2021 and March 2024 were retrospectively analyzed. The patients were divided into single-trunk group and double-trunk group according to the treatment methods. Clinical data including demographic characteristics, preoperative risk factors, surgical details, postoperative complications and long-term follow-up data were collected. Outcome measures mainly included surgical success rate, in-hospital mortality, endoleak rate and incidence of branch restenosis. Results Thirty-four patients with thoracoabdominal aortic dissection were treat with total endovascular treatment. That success rate of operation was 100%. The in-hospital mortality was 2.94%. the incidence of paraplegia was 0.00%. the incidence of cerebral infarction was 2.94%. The incidence of type Ⅲ endoleak was 5.88%. The incidence of branch artery stenosis was 8.82%. The incidence of dissection progression was 8.82%. The reintervention rate was 14.71%. In the aspect of reconstruction of splanchnic artery branches, fenestration stent was the main method in the single-trunk group, and branch stent was the main method in the double-trunk group, the difference was statistically significant (P<0.05). There was no significant difference in perioperative and mid-term follow-up results between the two groups (P>0.05). Conclusion Total endovascular treatment is a safe and effective treatment option for patients with thoracoabdominal aortic dissection.

Citation： HE Mengwei, QU jin, HUO Weixue, ZHANG Heng, LU Ye, TIAN Wen, ZENG Zhaoxiang, FENG Rui. Endovascular treatment outcomes of chronic thoracoabdominal aortic dissection. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(6): 664-670. doi: 10.7507/1007-9424.202405040 Copy

1.	Coselli JS, LeMaire SA, Preventza O, et al. Outcomes of 3 309 thoracoabdominal aortic aneurysm repairs. J Thorac Cardiovasc Surg, 2016, 151(5): 1323-1337.
2.	Antoniou GA, Juszczak MT, Antoniou SA, et al. Editor’s choice—Fenestrated or branched endovascular versus open repair for complex aortic aneurysms: Meta-analysis of time to event propensity score matched data. Eur J Vasc Endovasc Surg, 2021, 61(2): 228-237.
3.	Kuzniar MK, Wanhainen A, Tegler G, et al. Endovascular treatment of chronic aortic dissection with fenestrated and branched stent grafts. J Vasc Surg, 2021, 73(5): 1573-1582.
4.	Oderich GS, Ribeiro M, Reis de Souza L, et al. Endovascular repair of thoracoabdominal aortic aneurysms using fenestrated and branched endografts. J Thorac Cardiovasc Surg, 2017, 153(2): S32-S41. doi: 10.1016/j.jtcvs.2016.10.008.
5.	Zeng Z, Zhao Y, Ainiwaer A, et al. Physician-modified branched double-trunk stent-graft (PBDS) for Thoracoabdominal aortic aneurysm. Heart Lung Circ, 2021, 30(6): 896-901.
6.	Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
7.	Gallitto E, Faggioli G, Melissano G, et al. Fenestrated and branched endografts for post-dissection thoraco-abdominal aneurysms: Results of a national multicentre study and literature review. Eur J Vasc Endovasc Surg, 2022, 64(6): 630-638.
8.	Benfor B, Högl J, Gouveia E Melo R, et al. Postoperative outcomes and reinterventions following fenestrated/branched endovascular aortic repair in post-dissection and complex degenerative abdominal and thoraco-abdominal aortic aneurysms. J Clin Med, 2022, 11(16): 4768. doi: 10.3390/jcm11164768.
9.	Fattori R, Montgomery D, Lovato L, et al. Survival after endovascular therapy in patients with type B aortic dissection: a report from the International Registry of Acute Aortic Dissection (IRAD). JACC Cardiovasc Interv, 2013, 6(8): 876-882.
10.	Boufi M, Patterson BO, Loundou AD, et al. Endovascular versus open repair for chronic type B dissection treatment: A meta-analysis. Ann Thorac Surg, 2019, 107(5): 1559-1570.
11.	Kang PC, Bartek MA, Shalhub S, et al. Survival and patient-centered outcome in a disease-based observational cohort study of patients with thoracoabdominal aortic aneurysm. J Vasc Surg, 2019, 70(5): 1427-1435.
12.	Fattori R, Cao P, De Rango P, et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J Am Coll Cardiol, 2013, 61(16): 1661-1678.
13.	师天雄, 解孝章. 85例Stanford B型主动脉夹层腔内手术早中期随访结果分析. 中国普外基础与临床杂志, 2012, 19(1): 66-71.
14.	Kitagawa A, Greenberg RK, Eagleton MJ, et al. Fenestrated and branched endovascular aortic repair for chronic type B aortic dissection with thoracoabdominal aneurysms. J Vasc Surg, 2013, 58(3): 625-634.
15.	Kärkkäinen JM, Pather K, Tenorio ER, et al. Should endovascular approach be considered as the first option for thoraco-abdominal aortic aneurysms? J Cardiovasc Surg (Torino), 2019, 60(3): 298-312.
16.	Mylonas SN, Aras T, Dorweiler B. A systematic review and an updated meta-analysis of fenestrated/branched endovascular aortic repair of chronic post-dissection thoracoabdominal aortic aneurysms. J Clin Med, 2024, 13(2): 410. doi: 10.3390/jcm13020410.
17.	Werlin EC, Kaushik S, Gasper WJ, et al. Multibranched endovascular aortic aneurysm repair in patients with and without chronic aortic dissections. J Vasc Surg, 2019, 70(5): 1419-1426.
18.	Gallitto E, Faggioli G, Pini R, et al. Endovascular repair of thoraco-abdominal aortic aneurysms by fenestrated and branched endografts†. Eur J Cardiothorac Surg, 2019, 56(5): 993-1000.
19.	胡佳腾, 李逢时, 徐昕童, 等. 3D打印辅助预开窗及分支支架腔内修复术治疗胸腹主动脉瘤. 中华普通外科杂志, 2023, 38(7): 491-495.
20.	Han SM, Tenorio ER, Mirza AK, et al. Low-profile Zenith Alpha™ thoracic stent graft modification using preloaded wires for urgent repair of thoracoabdominal and pararenal abdominal aortic aneurysms. Ann Vasc Surg, 2020, 67: 14-25.
21.	刘光, 陆信武. 慢性Stanford B型主动脉夹层/动脉瘤的诊治. 中国血管外科杂志(电子版), 2021, 13(1): 4-7.
22.	王利新, 张宇翀, 符伟国. 主动脉夹层术后远端动脉瘤的处理. 外科理论与实践, 2022, 27(4): 309-313.
23.	Lombardi JV, Hughes GC, Appoo JJ, et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. Ann Thorac Surg, 2020, 109(3): 959-981.
24.	Katsargyris A, Marques de Marino P, Mufty H, et al. Early experience with the use of inner branches in endovascular repair of complex abdominal and thoraco-abdominal aortic aneurysms. Eur J Vasc Endovasc Surg, 2018, 55(5): 640-646.
25.	Wang X, Zhu Q, He Y, et al. Mid-term outcomes of physician-modified fenestrated or branched endovascular repair for post-dissection thoracoabdominal aortic aneurysms. Cardiovasc Intervent Radiol, 2022, 45(11): 1672-1681.
26.	何孟伟, 霍威学, 张恒, 等. 开窗/分支支架治疗胸腹主动脉扩张性病变的临床效果分析. 中国普通外科杂志, 2023, 32(12): 1882-1891.
27.	Li D, Ye L, He Y, et al. False lumen status in patients with acute aortic dissection: A systematic review and meta-analysis. J Am Heart Assoc, 2016, 5(5): e003172. doi: 10.1161/JAHA.115.003172.
28.	Kamman AV, Jonker FHW, Sechtem U, et al. Predictors of stable aortic dimensions in medically managed acute aortic syndromes. Ann Vasc Surg, 2017, 42: 143-149.
29.	景在平, 梅志军. 主动脉夹层腔内隔绝术后内漏的处理. 中国普外基础与临床杂志, 2006, 13(6): 632-633.
30.	Miletic KG, Kindzelski BA, Hodges KE, et al. c. Ann Thorac Surg, 2021, 111(2): 495-501.
31.	Pellenc Q, Roussel A, De Blic R, et al. False lumen embolization in chronic aortic dissection promotes thoracic aortic remodeling at midterm follow-up. J Vasc Surg, 2019, 70(3): 710-717.
32.	Eleshra A, Kölbel T, Tsilimparis N, et al. Candy-Plug GenerationⅡ for false lumen occlusion in chronic aortic dissection: feasibility and early results. J Endovasc Ther, 2019, 26(6): 782-786.
33.	Kölbel T, Lohrenz C, Kieback A, et al. Distal false lumen occlusion in aortic dissection with a homemade extra-large vascular plug: the candy-plug technique. J Endovasc Ther, 2013, 20(4): 484-489.
34.	Eleshra A, Rohlffs F, Spanos K, et al. Aortic remodeling after Custom-Made Candy-Plug for distal false lumen occlusion in aortic dissection. J Endovasc Ther, 2021, 28(3): 399-406.
35.	Law Y, Tsilimparis N, Rohlffs F, et al. Fenestrated or branched endovascular aortic repair for postdissection thoracoabdominal aortic aneurysm. J Vasc Surg, 2019, 70(2): 404-412.
36.	Oikonomou K, Kasprzak P, Katsargyris A, et al. Mid-term results of fenestrated/branched stent grafting to treat post-dissection thoraco-abdominal aneurysms. Eur J Vasc Endovasc Surg, 2019, 57(1): 102-109.
37.	Spear R, Hertault A, Van Calster K, et al. Complex endovascular repair of postdissection arch and thoracoabdominal aneurysms. J Vasc Surg, 2018, 67(3): 685-693.
38.	Marques De Marino P, Ibraheem A, Gafur N, et al. Outcomes of fenestrated and branched endovascular aortic repair for chronic post-dissection thoracoabdominal aortic aneurysms. J Cardiovasc Surg (Torino), 2020, 61(4): 427-434.
39.	Schneider DB, Oderich GS, Farber MA, et al. Target artery outcomes after branched and fenestrated endovascular repair of pararenal and thoracoabdominal aortic aneurysms in the US investigational device exemption experience. J Vasc Surg, 2018, 67(6): e83. doi: 10.1016/J.JVS.2018.03.076.
40.	Baker AC, Oderich GS. Principles of side branch incorporation and‘Bail Out’ maneuvers//Endovascular aortic repair: current techniques with fenestrated, branched and parallel stent-grafts. 1st ed. Berlin/Heidelberg, Germany, Springer: 2017: 277-294.

1. Coselli JS, LeMaire SA, Preventza O, et al. Outcomes of 3 309 thoracoabdominal aortic aneurysm repairs. J Thorac Cardiovasc Surg, 2016, 151(5): 1323-1337.
2. Antoniou GA, Juszczak MT, Antoniou SA, et al. Editor’s choice—Fenestrated or branched endovascular versus open repair for complex aortic aneurysms: Meta-analysis of time to event propensity score matched data. Eur J Vasc Endovasc Surg, 2021, 61(2): 228-237.
3. Kuzniar MK, Wanhainen A, Tegler G, et al. Endovascular treatment of chronic aortic dissection with fenestrated and branched stent grafts. J Vasc Surg, 2021, 73(5): 1573-1582.
4. Oderich GS, Ribeiro M, Reis de Souza L, et al. Endovascular repair of thoracoabdominal aortic aneurysms using fenestrated and branched endografts. J Thorac Cardiovasc Surg, 2017, 153(2): S32-S41. doi: 10.1016/j.jtcvs.2016.10.008.
5. Zeng Z, Zhao Y, Ainiwaer A, et al. Physician-modified branched double-trunk stent-graft (PBDS) for Thoracoabdominal aortic aneurysm. Heart Lung Circ, 2021, 30(6): 896-901.
6. Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
7. Gallitto E, Faggioli G, Melissano G, et al. Fenestrated and branched endografts for post-dissection thoraco-abdominal aneurysms: Results of a national multicentre study and literature review. Eur J Vasc Endovasc Surg, 2022, 64(6): 630-638.
8. Benfor B, Högl J, Gouveia E Melo R, et al. Postoperative outcomes and reinterventions following fenestrated/branched endovascular aortic repair in post-dissection and complex degenerative abdominal and thoraco-abdominal aortic aneurysms. J Clin Med, 2022, 11(16): 4768. doi: 10.3390/jcm11164768.
9. Fattori R, Montgomery D, Lovato L, et al. Survival after endovascular therapy in patients with type B aortic dissection: a report from the International Registry of Acute Aortic Dissection (IRAD). JACC Cardiovasc Interv, 2013, 6(8): 876-882.
10. Boufi M, Patterson BO, Loundou AD, et al. Endovascular versus open repair for chronic type B dissection treatment: A meta-analysis. Ann Thorac Surg, 2019, 107(5): 1559-1570.
11. Kang PC, Bartek MA, Shalhub S, et al. Survival and patient-centered outcome in a disease-based observational cohort study of patients with thoracoabdominal aortic aneurysm. J Vasc Surg, 2019, 70(5): 1427-1435.
12. Fattori R, Cao P, De Rango P, et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J Am Coll Cardiol, 2013, 61(16): 1661-1678.
13. 师天雄, 解孝章. 85例Stanford B型主动脉夹层腔内手术早中期随访结果分析. 中国普外基础与临床杂志, 2012, 19(1): 66-71.
14. Kitagawa A, Greenberg RK, Eagleton MJ, et al. Fenestrated and branched endovascular aortic repair for chronic type B aortic dissection with thoracoabdominal aneurysms. J Vasc Surg, 2013, 58(3): 625-634.
15. Kärkkäinen JM, Pather K, Tenorio ER, et al. Should endovascular approach be considered as the first option for thoraco-abdominal aortic aneurysms? J Cardiovasc Surg (Torino), 2019, 60(3): 298-312.
16. Mylonas SN, Aras T, Dorweiler B. A systematic review and an updated meta-analysis of fenestrated/branched endovascular aortic repair of chronic post-dissection thoracoabdominal aortic aneurysms. J Clin Med, 2024, 13(2): 410. doi: 10.3390/jcm13020410.
17. Werlin EC, Kaushik S, Gasper WJ, et al. Multibranched endovascular aortic aneurysm repair in patients with and without chronic aortic dissections. J Vasc Surg, 2019, 70(5): 1419-1426.
18. Gallitto E, Faggioli G, Pini R, et al. Endovascular repair of thoraco-abdominal aortic aneurysms by fenestrated and branched endografts†. Eur J Cardiothorac Surg, 2019, 56(5): 993-1000.
19. 胡佳腾, 李逢时, 徐昕童, 等. 3D打印辅助预开窗及分支支架腔内修复术治疗胸腹主动脉瘤. 中华普通外科杂志, 2023, 38(7): 491-495.
20. Han SM, Tenorio ER, Mirza AK, et al. Low-profile Zenith Alpha™ thoracic stent graft modification using preloaded wires for urgent repair of thoracoabdominal and pararenal abdominal aortic aneurysms. Ann Vasc Surg, 2020, 67: 14-25.
21. 刘光, 陆信武. 慢性Stanford B型主动脉夹层/动脉瘤的诊治. 中国血管外科杂志(电子版), 2021, 13(1): 4-7.
22. 王利新, 张宇翀, 符伟国. 主动脉夹层术后远端动脉瘤的处理. 外科理论与实践, 2022, 27(4): 309-313.
23. Lombardi JV, Hughes GC, Appoo JJ, et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. Ann Thorac Surg, 2020, 109(3): 959-981.
24. Katsargyris A, Marques de Marino P, Mufty H, et al. Early experience with the use of inner branches in endovascular repair of complex abdominal and thoraco-abdominal aortic aneurysms. Eur J Vasc Endovasc Surg, 2018, 55(5): 640-646.
25. Wang X, Zhu Q, He Y, et al. Mid-term outcomes of physician-modified fenestrated or branched endovascular repair for post-dissection thoracoabdominal aortic aneurysms. Cardiovasc Intervent Radiol, 2022, 45(11): 1672-1681.
26. 何孟伟, 霍威学, 张恒, 等. 开窗/分支支架治疗胸腹主动脉扩张性病变的临床效果分析. 中国普通外科杂志, 2023, 32(12): 1882-1891.
27. Li D, Ye L, He Y, et al. False lumen status in patients with acute aortic dissection: A systematic review and meta-analysis. J Am Heart Assoc, 2016, 5(5): e003172. doi: 10.1161/JAHA.115.003172.
28. Kamman AV, Jonker FHW, Sechtem U, et al. Predictors of stable aortic dimensions in medically managed acute aortic syndromes. Ann Vasc Surg, 2017, 42: 143-149.
29. 景在平, 梅志军. 主动脉夹层腔内隔绝术后内漏的处理. 中国普外基础与临床杂志, 2006, 13(6): 632-633.
30. Miletic KG, Kindzelski BA, Hodges KE, et al. c. Ann Thorac Surg, 2021, 111(2): 495-501.
31. Pellenc Q, Roussel A, De Blic R, et al. False lumen embolization in chronic aortic dissection promotes thoracic aortic remodeling at midterm follow-up. J Vasc Surg, 2019, 70(3): 710-717.
32. Eleshra A, Kölbel T, Tsilimparis N, et al. Candy-Plug GenerationⅡ for false lumen occlusion in chronic aortic dissection: feasibility and early results. J Endovasc Ther, 2019, 26(6): 782-786.
33. Kölbel T, Lohrenz C, Kieback A, et al. Distal false lumen occlusion in aortic dissection with a homemade extra-large vascular plug: the candy-plug technique. J Endovasc Ther, 2013, 20(4): 484-489.
34. Eleshra A, Rohlffs F, Spanos K, et al. Aortic remodeling after Custom-Made Candy-Plug for distal false lumen occlusion in aortic dissection. J Endovasc Ther, 2021, 28(3): 399-406.
35. Law Y, Tsilimparis N, Rohlffs F, et al. Fenestrated or branched endovascular aortic repair for postdissection thoracoabdominal aortic aneurysm. J Vasc Surg, 2019, 70(2): 404-412.
36. Oikonomou K, Kasprzak P, Katsargyris A, et al. Mid-term results of fenestrated/branched stent grafting to treat post-dissection thoraco-abdominal aneurysms. Eur J Vasc Endovasc Surg, 2019, 57(1): 102-109.
37. Spear R, Hertault A, Van Calster K, et al. Complex endovascular repair of postdissection arch and thoracoabdominal aneurysms. J Vasc Surg, 2018, 67(3): 685-693.
38. Marques De Marino P, Ibraheem A, Gafur N, et al. Outcomes of fenestrated and branched endovascular aortic repair for chronic post-dissection thoracoabdominal aortic aneurysms. J Cardiovasc Surg (Torino), 2020, 61(4): 427-434.
39. Schneider DB, Oderich GS, Farber MA, et al. Target artery outcomes after branched and fenestrated endovascular repair of pararenal and thoracoabdominal aortic aneurysms in the US investigational device exemption experience. J Vasc Surg, 2018, 67(6): e83. doi: 10.1016/J.JVS.2018.03.076.
40. Baker AC, Oderich GS. Principles of side branch incorporation and‘Bail Out’ maneuvers//Endovascular aortic repair: current techniques with fenestrated, branched and parallel stent-grafts. 1st ed. Berlin/Heidelberg, Germany, Springer: 2017: 277-294.

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Endovascular treatment outcomes of chronic thoracoabdominal aortic dissection

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