STABILISE; treatment of aortic dissection, a single Centre experience

Goran Mitreski,Jason Chuen,Hamed Asadi,Dinesh Ranatunga,Damian Flanders,Siven Seevanayagam,Duncan Mark Brooks,Domenic Robinson,Hong Kuan Kok,Julian Maingard,George Matalanis

doi:10.1186/s42155-022-00286-2

Goran Mitreski, Jason Chuen + Show 9 more

Open Access

https://doi.org/10.1186/s42155-022-00286-2

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Journal: CVIR endovascular	Publication Date: Jan 27, 2022
Citations: 6	License type: open-access

Affiliation: Austin Health, Northern Health, Monash Health

Abstract

PurposeTo outline the process of the STABILISE technique and its use; reporting patient outcomes and midterm follow up for complicated aortic dissection.Materials and methodsSingle centre retrospective analysis from January 2011 to January 2021 using the STABILISE technique which utilises balloon assistance to facilitate intimal disruption and promote aortic relamination.ResultsSixteen patients underwent endovascular aortic repair with the STABILISE technique for aortic dissection over the study period. Fourteen patients (14/16; 88%) had acute dissection. Two of 16 (12%) were chronic. The median age of the patient cohort was 61 years (range 32–80 years) and consisted of a male majority (n = 11; 69%). The median time from diagnosis to intervention was 5 days (1–115 days; IQR 1–17.3). More than half (56%) had surgical repair of a acute type A aortic dissection prior to radiological intervention. The procedure was technically successful with no procedural mortality. Two patients were lost to follow up and two died in the post-operative period. Twelve patients had ongoing follow up with an average number of 2.9 ± 1.6 scans performed. Follow up was available in thirteen patients (81%) with a median follow up period of 1097 days (IQR 707–1657). The rate of re-intervention (n = 2/16; 13%) requiring additional stenting was in line with published re-intervention data (15%). Follow up showed a reduction in false lumen size following treatment with total luminal dimensions remaining stable over the follow-up period.ConclusionThe STABILISE technique as a procedure for complicated aortic dissection, either acute or chronic, appears safe with stable mid-term aortic remodelling and patient outcomes.Level of evidenceLevel 3, Retrospective cohort study.

Highlights

Aortic dissection is an important cause of morbidity and mortality worldwide
We report the outcomes of a consecutive series of patients undergoing the STABILISE technique for complicated aortic dissection at a quaternary teaching hospital in Australia
Patients Between January 2011 to January 2020, all patients who underwent endovascular repair (EVAR and thoracic endovascular aortic repair (TEVAR)) for type A and B dissection using the STABILISE technique were included in the study

Summary

Introduction

Aortic dissection is an important cause of morbidity and mortality worldwide. Acute aortic dissection, occurring within a 2 week period of symptom onset (Nienaber & Powell, 2012) is part of the spectrum of acute aortic syndrome. 2008) Reduced post-operative mortality (30 day; 7.9% vs 20% and 1 year; 8.7% vs 17%), in addition to reduced procedural complications, have been demonstrated in those undergoing TEVAR compared with open repair (Harky et al, 2020; Hsieh et al, 2019). Despite these benefits, meta-analyses have shown TEVAR to be associated with pooled reintervention rates of 15%; reasons including, endoleak (33.2%), false-lumen perfusion and aortic dilation (19.8%), and new dissection (6.9%). Meta-analyses have shown TEVAR to be associated with pooled reintervention rates of 15%; reasons including, endoleak (33.2%), false-lumen perfusion and aortic dilation (19.8%), and new dissection (6.9%). (Faure et al, 2014; Zhang et al, 2016)

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