Standing the test of time: total aortic remodeling 13 years after TEVAR for acute type B aortic dissection

Matthias Niklas Hagedorn, Katrin Meisenbacher, Denis Skrypnik, Moritz Sebastian Bischoff, Dittmar Böckler, Matthias Niklas Hagedorn, Katrin Meisenbacher, Denis Skrypnik, Moritz Sebastian Bischoff, Dittmar Böckler

Abstract

Long-term outcome after thoracic endovascular aortic repair (TEVAR) of acute type B aortic dissection (aTBAD) is still underreported in current literature. This case report shows persistence of aortic remodeling without secondary complication or need of reintervention 13 years after TEVAR. A 45-year-old woman was referred to the emergency room with aTBAD. Due to early diameter progression in combination with therapy-refractory pain and uncontrolled hypertension, TEVAR was performed. Hereafter, the patient showed complete remodeling of the descending thoracic aorta without persistent false lumen perfusion in this segment and with stable true and false lumen diameter in the untreated abdominal segment for a 13-year period. No aortic-related reintervention was needed. With contemporary devices and adapted therapy, TEVAR seems able to treat complex thoracic disease. Long-term follow-up (FU) is mandatory to monitor the efficacy and durability of endovascular treatment in aortic disease.

Keywords: Descending aorta; Endovascular treatment/therapy; Long-term follow-up; Thoracic endovascular aortic repair; Type B dissection.

Conflict of interest statement

Conflict of interestThe authors declare no competing interests.

© The Author(s) 2023.

Figures

Fig. 1
Fig. 1
Initial CTA (A sagittal, B axial) showing an intramural hematoma followed by a true aortic dissection reaching from the left subclavian artery to the aortic bifurcation. CTA, computed tomography angiography
Fig. 2
Fig. 2
3D reconstruction of an MRA 7 years after TEVAR implantation with almost complete aortic remodeling. 3D, three-dimensional; MRA, magnetic resonance angiography; TEVAR, thoracic endovascular aortic repair
Fig. 3
Fig. 3
Preoperative (A) and 13 years after TEVAR (B) 3D reconstruction of the CTA of the thoracic aorta. 3D, three-dimensional; CTA, computed tomography angiography; TEVAR, thoracic endovascular aortic repair

References

    1. Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Jr, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010;121:e266–369.
    1. Nassib J, Hireche K, Ozdemir BA, Alric P, Canaud L. Fate of the dissected thoraco-abdominal aorta distal to TEVAR (Thoracic Endovascular Aortic Repair) for complicated acute and subacute type B aortic dissection. J Endovasc Ther. 2022;29(5):773–779. doi: 10.1177/15266028211065964.
    1. Bertoglio L, Rinaldi E, Melissano G, Chiesa R. The PETTICOAT concept for endovascular treatment of type B aortic dissection. J Cardiovasc Surg (Torino) 2019;60:91–99.
    1. Bischoff MS, Müller-Eschner M, Meisenbacher K, Peters AS, Böckler D. Device conformability and morphological assessment after TEVAR for aortic type B dissection: a single-centre experience with a conformable thoracic stent-graft design. Med Sci Monit Basic Res. 2015;21:262–270. doi: 10.12659/MSMBR.897010.
    1. Skrypnik D, Bischoff MS, Meisenbacher K, Kronsteiner DB, Böckler D. A 10-year single-center experience with the GORE TAG conformable thoracic stent graft in the treatment of thoracic aortic disease. J Endovasc Ther. 2022;29:370–380. doi: 10.1177/15266028211049340.

Source: PubMed

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