Hybrid two-stage repair of Stanford A dissection with visceral or peripheral malperfusion

Zanxin Wang,Minxin Wei,Xianmian Zhuang,Junmin Wen,Bailang Chen

doi:10.1186/s13019-020-01307-8

Abstract

BackgroundThe present study aimed to evaluate the effect of two-stage hybrid aortic repair at the distal aorta of Stanford A dissection with malperfusion.MethodsThis retrospective case series included 20 patients with Stanford A dissection administered two-stage thoracic endovascular aortic repair (TEVAR) about 1 month after central repair because of visceral or limb malperfusion. The patients were examined by computed tomography (CT) angiography at 3, 6, 12 and 24 months after operation. Recovery of malperfusion and true lumen index were evaluated during follow-up.ResultsTwenty patients underwent two-stage hybrid aortic repair, including 11 males and 9 females. The follow-up time was 24 ± 7 months. No intervention-related complications were observed, including stent graft-induced new re-entry tears, death, stroke and spinal cord injury. Malperfusion in all cases was corrected. The true lumen was not enlarged enough 1 month after the first surgery. Thrombosis of the false lumen was observed around the elephant trunk at the carina level and the celiac artery. Three months after second stage TEVAR, the false lumen thrombosis was resorbed; in addition, the trunk was fully expanded at the carina level, and the true lumen was enlarged at the celiac artery.ConclusionsTwo-stage hybrid aortic repair for residual true lumen in the distal aorta 1 month after initial surgery is helpful for descending aorta remodeling and effective in treating malperfusion. This procedure may be a good option for patients suffering from Stanford A dissection with small true lumen in the distal aorta and malperfusion.

Highlights

The present study aimed to evaluate the effect of two-stage hybrid aortic repair at the distal aorta of Stanford A dissection with malperfusion
Stanford A aortic dissection is an acute condition characterized by the disruption of the thoracic aortic media layer caused by intramural bleeding separating the aortic wall layers; it leads to the formation of true and false lumen with or without communication [1,2,3,4]
One patient had failed thoracic endovascular aortic repair (TEVAR), because the elephant trunk was inserted into the false lumen

Summary

Introduction

The present study aimed to evaluate the effect of two-stage hybrid aortic repair at the distal aorta of Stanford A dissection with malperfusion. The malperfusion syndrome can affect different vascular beds depending upon the exact location of the aortic tear: spinal cord, visceral, renal, and lower extremities [7, 8]. It is found in 20–40% of patients with Stanford A aortic dissection. Wang et al Journal of Cardiothoracic Surgery (2020) 15:265. Early diagnosis is important in avoiding damage to organs and the subsequent inflammatory cascade that can affect the treatment success and patient prognosis [7, 8]

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Conclusion