aortic symposium new york 2012 „pseudoaneurysm after endovascular stent graft placement for...
TRANSCRIPT
Aortic Symposium
New York 2012
„Pseudoaneurysm After Endovascular Stent Graft
Placement for Treatment of Type B Aortic Dissection“
R.A. Jánosi, M. Bettin, T. Konorza, H. Kälsch, H. Eggebrecht, R. Erbel
Department of CardiologyWest German Heart Center Essen
Patient Characteristics
no DPA DPA p
patients 143 (95 %) 8 (5 %)
male 96 (63 %) 5 (63 %) 0,786
age (y) 62,2 ± 12,8 (22-84) 60,7 ± 8,7 (48-71) 0,746
Time to Treatment (mo) 4,3 ± 11,9 20,3 ± 36,3 0,251
acute dissection 62 1 0,64
stent graft diameter (mm) 34,0 ± 5,1 33,0 ± 1,5 0,589
stent graft length (mm) 153,2 ± 43,1 158,1 ± 40,0 0,753
Angle (°) 167,1 ± 12,4 148,2 ± 16,5 <0,05
reintervention 18 (13 %) 7 (88 %)* <0,05
Time to reintervention (mo) 27,8 ± 24,6 19,1 ± 15,1 0,364
Characteristics of 8 patients complicated with DPA afterEndografting for Type B Dissection
patient
Age Initial Indication Coexisting conditions
Onset timeIntervention>diagnosis DPA (mo)
Stent graft extension
Duration of follow up (mo)
DPA (mm)
Stent
1 70 Recurrent pain, impending rupture
HTN 16 yes 45 15x35 Valiant
2 59 Recurrent pain HTN 3 yes 27 22x34 Relay
3 47 Recurrent pain, Malperfusion
HTN 19 yes 27 10x16 Valiant
4 68 Recurrent pain HTN 50 yes 80 39x44 Talent
5 67 Recurrent pain HTN, MI
76 yes 109 20x34 Talent
6 65 Recurrent pain HTN, CHD
14 yes 13 13x25 Relay
7 58 Recurrent pain HTN 115 refused 115 - Talent
8 49 Progredient FL-aneurysm
HTN 26 yes 26 9x28 Valiant
10,08,06,04,02,00,0
Zeit TEVAR bis Reintervention
1,0
0,8
0,6
0,4
0,2
0,0
Ver
lau
f o
hn
e R
ein
terv
enti
on
nein-censored
ja-censored
nein
ja
DistalesPseudoaneurysma
Rat
e of
free
dom
Rei
nter
vent
ion
years
DistalPseudoaneurysm
YesNoYes-censoredNo-censored
When passively bent at the arch, the self-expanding stent graft has theinherent tendency to spring back toits initial straight status.
When passively bent at the arch, the self-expanding stent graft has theinherent tendency to spring back toits initial straight status.
Conclusions
•Endovascular treatment in chronic type B dissection has a
high technical success rate and low mortality•Pseudoaneurysm of the thoracic aorta is a rare and
potentially fatal condition•Potential mechanism:
• Trauma caused by the semi-rigid stent graft• Fragility of the aortic wall and disease progression• Excessive radial force due to distal oversizing of the
stent graft prosthesis to > 20%Development of dissection-specific, less-rigid endo-
prosthesis
Characteristics of 8 patients complicated with DPA afterEndografting for Type B Dissection
patient
Age Initial Indication Coexisting conditions
Oversizing
Onset timeIntervention>diagnosis DPA (mo)
Stent graft extension
Duration of follow up (mo)
DPA (mm)
Stent
1 70 Recurrent pain, impending rupture
HTN 16 yes 45 15x35 Valiant
2 59 Recurrent pain HTN 3 yes 27 22x34 Relay
3 47 Recurrent pain, Malperfusion
HTN 19 yes 27 10x16 Valiant
4 68 Recurrent pain HTN 50 yes 80 39x44 Talent
5 67 Recurrent pain HTN, MI
76 yes 109 20x34 Talent
6 65 Recurrent pain HTN, CHD
14 yes 13 13x25 Relay
7 58 Recurrent pain HTN 115 refused 115 - Talent
8 49 Progredient FL-aneurysm
HTN 26 yes 26 9x28 Valiant