TEVAR in Acute Type A Aortic Dissection

Objectives: In this study, we want to present our initial experience with endovascular repair of acute type A aortic dissections (ATAAD) as a bail-out strategy in special cases. Further we want to demonstrate the variety of treatment strategies in different types of type-A aortic dissections.

Methods: We retrospectively screened a single-center database of aortic dissections. We included patients in this study who (1) suffered from an ATAAD, (2) in whom ATAAD was treated with endovascular stent grafts, (3) with complete clinical and imaging data of good quality.

Result: According to the inclusion criteria we analyzed four patients (three males) with a mean age of 80 (±9.6) years. Two patients had a local ascending dissection, one patient had a retrograde type-A dissection after TEVAR for a descending aortic aneurysm and one patient had a Debakey type I dissection. The mean duration of the procedure was 163 (± 99.8) min. In one patient the approach was trans-apical due to massive calcification of the femoral arteries. All the other patients were treated with a trans-femoral approach. One patient needed a carotid-subclavian bypass due to overstenting of the proximal intimal lesion of the retrograde dissection after TEVAR implantation. The proximal segments, the arch and the distal ascending aorta, were treated with an uncovered stent prosthesis to adapt the dissected membrane to the aortic wall. The proximal oversizing was 13 (± 1.5)% and the distal oversizing was 27 (± 10)%. The technical success rate was 100%. The FL was successfully sealed and completely thrombosed in the post-TEVAR CT. The mean TL CSA increased in every patient (from 876 ± 428 mm² to 1,041 ± 323 mm²), and the mean FL CSA decreased in every patient (from 416 ± 273 mm² to 372 ± 435 mm²). The mortality rate for the first 30 days was 0%.

Conclusion: Our first experience with TEVAR for ATAAD showed that TEVAR may be a valuable tool in selected patients with suitable morphology of dissection.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021