A Novel Solution for Distal Dilation of Chronic Dissection After Repair Involving Visceral Branches: The Road Block Strategy.

Yiming Li,Rui Feng,Zhenjiang Li,Jiaxuan Feng,Zaiping Jing,Jian Zhou

doi:10.3389/fcvm.2022.821260

Abstract

AimNotwithstanding that unprecedented endovascular progress has been achieved in recent years, it remains unclear what is the best strategy to preserve the blood perfusion of abdominal visceral arteries and promote positive aortic remodeling in patients with distal dilatation of chronic aortic dissection in abdominal visceral part (CADAV) after aortic repair. The present study developed a Road Block Strategy (RBS) to solve this conundrum.Methods and ResultsThis prospective single-center clinical study included patients suffering from symptomatic distal dilatation of CADAV after aortic repair treated with RBS from January 2015 to December 2019 and followed up regularly for at least 2 years. Stent grafts were implanted first to cover distal tears and expand the true lumen. Device embolization was performed to induce proximal and distal segmental false lumen thrombosis (FLT) apart from the level of the ostia of vital branches. Successful RBS was performed in 13 patients. Significant differences were found in maximum true lumen diameter (p < 0.05), blood flow area in false lumen (FL) (p < 0.001), and the ratio of blood lumen to FL area (p < 0.05) between the pre-procedure and the latest follow-up results. No aortic rupture, vital branches occlusion, thoracic and abdominal pain, or death occurred during hospitalization and follow-up.ConclusionsOur findings suggest that RBS is feasible in treating distal dilatation of chronic aortic dissection after prior proximal repair, inducing false lumen thrombosis, preventing deterioration of aortic dissection, and maintaining the patency of abdominal visceral arteries.

Highlights

Aortic dissection is one of the most dangerous vascular diseases [1, 2], given that it can cause an aortic rupture in a short period leading to death [3, 4]
The inclusion criteria were [1] Period between surgery and aortic dissection onset >90 days; [2] At least one visceral artery is supplied by false lumen (FL); [2] Having symptoms associated with aortic dissection recently or maximum diameter of abdominal aorta >45 mm, or maximum diameter of abdominal aorta growth rate >5 mm per year, confirmed by computed tomographic angiography (CTA); and [4] Proximal aortic dissection had been treated by open surgery, hybrid surgery, or endovascular repair
Given that the proximal tears of the aortic dissection were already excluded, we evaluated for endoleaks and the need for stenting

Summary

Introduction

Aortic dissection is one of the most dangerous vascular diseases [1, 2], given that it can cause an aortic rupture in a short period leading to death [3, 4]. Complications after TEVAR seriously affect aortic dissection’s prognosis, most of which need to be resolved. Distal dilatation is one of the common complications of chronic aortic dissection in the visceral part (CADAV) after proximal TEVAR, often involving the visceral artery arising from the sac or false lumen (FL) [7]. Distal dilatation has been reported in onethird of chronic aortic dissection patients after proximal entry tears exclusion [8]. Regression analysis showed that visceral branches arising from the FL represent an independent risk factor [odds ratio (OR) = 10.1] for negative abdominal aortic remodeling [9]. Covered stents cannot exclude all the tears, multilayer stents do not reduce the blood pressure in the FL, the risk of endoleak is still present with the fenestration technique and the chimney graft tends to be occluded [7, 10]

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