Abstract
This present study aims to investigate the changes in the inflammatory markers after elective endovascular treatment of Type B aortic dissection with aneurysm, as related to different anatomical features of the dissection flap in the paravisceral perfusion. Consecutive patients with type B aortic dissections with elective endovascular stent graft repair were recruited and categorized into different groups. Serial plasma levels of cytokines (Interleukin-1β, -6, -8, -10, TNF-α), chemokines (MCP-1), and serum creatinine were monitored at pre-, peri- and post-operative stages. The length of stent graft employed in each surgery was retrieved and correlated with the change of all studied biochemical parameters. A control group of aortic dissected patients with conventional medication management was recruited for comparing the baseline biochemical parameters. In total, 22 endovascular treated and 16 aortic dissected patients with surveillance were recruited. The endovascular treated patients had comparable baseline levels as the non-surgical patients. There was no immediate or thirty day-mortality, and none of the surgical patients developed post-operative mesenteric ischaemia or clinically significant renal impairment. All surgical patients had detectable pro-inflammatory mediators, but none of the them showed any statistical significant surge in the peri-operative period except IL-1β and IL-6. Similar results were obtained when categorized into different groups. IL-1β and IL-6 showed maximal levels within hours of the endovascular procedure (range, 3.93 to 27.3 higher than baseline; p = 0.001), but returned to baseline 1 day post-operatively. The change of IL-1β and IL-6 at the stent graft deployment was statistically greater in longer stent graft (p>0.05). No significant changes were observed in the serum creatinine levels. In conclusion, elective endovascular repair of type B aortic dissection associated with insignificant changes in inflammatory mediators and creatinine. All levels fell toward basal levels post-operatively suggesting that thoracic endovascular aortic repair is rather less aggressive with insignificant inflammatory modulation.
Highlights
IntroductionAortic dissection is a tear in the intima (inner lining) of the aorta followed by propagation of subintimal blood and creating a new false channel in the media (middle layer) of the aorta [1]
Aortic dissection is a tear in the intima of the aorta followed by propagation of subintimal blood and creating a new false channel in the media of the aorta [1]
A total of twenty-three patients with chronic type B aortic dissecting aneurysm who underwent endovascular repair were recruited in the study
Summary
Aortic dissection is a tear in the intima (inner lining) of the aorta followed by propagation of subintimal blood and creating a new false channel in the media (middle layer) of the aorta [1]. It may be complicated by rupture, aneurysmal dilatation, end organ ischaemia, or persistent pain and discomfort [2]. The procedure involves covering the primary intimal entry tear with a stentgraft, followed ideally by depressurization and thrombosis of the false lumen, at the expense of the true lumen [4] This treatment alleviates pain, limits further dissection, and prevents aneurysm formation and other complications, the verdict is still out as to long-term survival benefit [5,6]
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