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Risk factors of long-term aortic dilatation after endovascular treatment for DeBakey IIIb aortic dissection
S116
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Tuesday
Scientific Session
thrombotic complications (OR, 1.18; 95% CI, 0.68-2.03). Mortality was significantly higher in the stent-assisted group 1.8% (range: 0%-27.5%) compared to the coiling-only group 0.2% (range:0%-19.7%) (OR, 2.85; 95% 1.22-6.66). However, the one RCT demonstrated mortality was similar between stentassisted coiling (2.3%) and coiling only (2.0%). Conclusions: Stent-assisted coiling shows similar immediate occlusion rates, improved progressive thrombosis and decreased aneurysm recurrence compared to coiling-only, but is associated with a higher mortality rate. Future randomised controlled trials are warranted to clarify the safety of stentassociated coiling.
3:54 PM
Abstract No. 253
Risk factors of long-term aortic dilatation after endovascular treatment for DeBakey IIIb aortic dissection
TUESDAY: Scientific Sessions
W. Ding1, G. Teng2, B. Xie2; 1Yixing People’s Hospital, Yixingshi, Yixing Jiangsu; 2Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu. Purpose: To investigate the risk factors of long-term aortic dilatation after thoracic endovascular aortic repair (TEVAR) of DeBakey IIIb aortic dissection (DeBakey IIIb-AD). Materials: Between August 2005 and August 2014, we retrospectively analyzed 112 patients who underwent TEVAR for DeBakey IIIb-AD from two large referral centers. The main data were demographics, clinical features, procedural details, preoperative and postoperative imaging characteristics, decending thoracic and abdominal (divided by the celiac axis) aortic dilatation after TEVAR during follow-up. The dilatation was defined as a 45mm increase in the maximum transaortic diameter at a follow-up CTA compared with the preoperative measurement at each corresponding aortic segment, respectively. Stepwise Cox regression analysis was performed to study independent risk factors of postoperative decending thoracic and abdominal aortic dilatation, respectively. Results: Through an average imaging follow-up of 30.42±20.02 months, among these 112 postoperative patients, 37 (33.0%) developed decending thoracic aortic dilatation, and 19 (17.0%) had abdominal aortic dilatation. Univariate analysis revealed several risk factors. Then further analysis with Cox proportional hazard model displayed that, cumulative size of residual intimal tears on decending thoracic aorta (hazard ratio [HR], 1.297; 95% confidence interval [95% CI], 1.189-1.414; Po0.001), distal stent graft-induced new entry (dSINE) (HR, 7.097; 95% CI, 2.61619.250; Po0.001), and type Ia endoleak (HR, 11.879; 95% CI, 5.027-28.068; Po0.001) were the independent risk factors of decending thoracic aortic dilatation after TEVAR; whereas, cumulative size of residual intimal tears on abdominal aorta (HR, 1.161; 95% CI, 1.089-1.238; Po0.001) was the only independent risk factor of abdominal aortic dilatation postoperatively. Conclusions: Cumulative size of residual intimal tears on decending thoracic aorta, dSINE, and type Ia endoleak were the independent risk factors of decending thoracic aortic dilatation after TEVAR of DeBakey IIIb-AD; while cumulative size of residual intimal tears on abdominal aorta
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JVIR
was the only independent risk factor of postoperative abdominal aortic dilatation. References 1. Fattori R, Cao P, De Rango P, Czerny M, Evangelista A, Nienaber C, et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J AM COLL CARDIOL. 2013;61ı¨ ¼sˇ 1661-78. 2. Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). EUR HEART J. 2014;35ı¨ ¼sˇ 2873-926. 3. Goldfinger JZ, Halperin JL, Marin ML, Stewart AS, Eagle KA, Fuster V. Thoracic aortic aneurysm and dissection. J AM COLL CARDIOL. 2014;64ı¨ ¼sˇ 1725-39. 4. Singh M, Hager E, Avgerinos E, Genovese E, Mapara K, Makaroun M. Choosing the correct treatment for acute aortic type B dissection. J Cardiovasc Surg (Torino). 2015;56ı¨ ¼sˇ 217-29.
4:03 PM
Abstract No. 254
Predictors of late false lumen enlargement after thoracic stent-graft placement for type-B aortic dissection A. Gasparetto1, K. Park2, S. Sabri3, A. Park4, A. Matsumoto5, J. Angle3; 1University of Virginia, Baltimore, MD; 2Samsung Medical Center, Sungkyunkwan University School, Seoul, Republic of Korea; 3Charlottesville, VA; 4UVA Health System, Charlottesville, VA; 5University of Virginia Health System, Charlottesville, VA. Purpose: To evaluate anatomic factors related to delayed aortic outer diameter (OD) and false lumen (FL) enlargement in patients undergoing thoracic stent graft placement for Type-B aortic dissection. Materials: A retrospective review of thoracic endovascular aortic repair (TEVAR) for type-B aortic dissection between January 2005 and May 2015 at a single institution was performed. Pre- and post-procedure CTA were analyzed for false lumen (FL) diameter, aortic outer diameter (OD) and sources of persistent FL filling after endograft placement. Imaging and clinical variables were assessed through univariate analysis to study their relationship with FL enlargement. Results: Sixty-two patients (45 males and 17 females) aged 26 to 80 years old (mean age: 58.1) were identified. Follow up period ranged from 3 to 104 months (mean 27.1 months). FL or OD increased more than 5mm in 12/62 patients (19.4%) and 10/12 underwent re-intervention (po.001). Patients featuring multiple types of inflow into the FL after endograft placement had increased risk of FL or OD enlargement (p¼.003) while patients with complete FL thrombosis were less likely to present with FL or OD enlargement (po.001). Conclusions: Spontaneous FL thrombosis is the best predictor of FL and aortic growth. Early intervention to decrease the number of FL flow sources after endograft placement for type B dissection may help prevent expansion of the FL and reduce the need for late reinterventions.
’
Tuesday
Scientific Session
thrombotic complications (OR, 1.18; 95% CI, 0.68-2.03). Mortality was significantly higher in the stent-assisted group 1.8% (range: 0%-27.5%) compared to the coiling-only group 0.2% (range:0%-19.7%) (OR, 2.85; 95% 1.22-6.66). However, the one RCT demonstrated mortality was similar between stentassisted coiling (2.3%) and coiling only (2.0%). Conclusions: Stent-assisted coiling shows similar immediate occlusion rates, improved progressive thrombosis and decreased aneurysm recurrence compared to coiling-only, but is associated with a higher mortality rate. Future randomised controlled trials are warranted to clarify the safety of stentassociated coiling.
3:54 PM
Abstract No. 253
Risk factors of long-term aortic dilatation after endovascular treatment for DeBakey IIIb aortic dissection
TUESDAY: Scientific Sessions
W. Ding1, G. Teng2, B. Xie2; 1Yixing People’s Hospital, Yixingshi, Yixing Jiangsu; 2Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu. Purpose: To investigate the risk factors of long-term aortic dilatation after thoracic endovascular aortic repair (TEVAR) of DeBakey IIIb aortic dissection (DeBakey IIIb-AD). Materials: Between August 2005 and August 2014, we retrospectively analyzed 112 patients who underwent TEVAR for DeBakey IIIb-AD from two large referral centers. The main data were demographics, clinical features, procedural details, preoperative and postoperative imaging characteristics, decending thoracic and abdominal (divided by the celiac axis) aortic dilatation after TEVAR during follow-up. The dilatation was defined as a 45mm increase in the maximum transaortic diameter at a follow-up CTA compared with the preoperative measurement at each corresponding aortic segment, respectively. Stepwise Cox regression analysis was performed to study independent risk factors of postoperative decending thoracic and abdominal aortic dilatation, respectively. Results: Through an average imaging follow-up of 30.42±20.02 months, among these 112 postoperative patients, 37 (33.0%) developed decending thoracic aortic dilatation, and 19 (17.0%) had abdominal aortic dilatation. Univariate analysis revealed several risk factors. Then further analysis with Cox proportional hazard model displayed that, cumulative size of residual intimal tears on decending thoracic aorta (hazard ratio [HR], 1.297; 95% confidence interval [95% CI], 1.189-1.414; Po0.001), distal stent graft-induced new entry (dSINE) (HR, 7.097; 95% CI, 2.61619.250; Po0.001), and type Ia endoleak (HR, 11.879; 95% CI, 5.027-28.068; Po0.001) were the independent risk factors of decending thoracic aortic dilatation after TEVAR; whereas, cumulative size of residual intimal tears on abdominal aorta (HR, 1.161; 95% CI, 1.089-1.238; Po0.001) was the only independent risk factor of abdominal aortic dilatation postoperatively. Conclusions: Cumulative size of residual intimal tears on decending thoracic aorta, dSINE, and type Ia endoleak were the independent risk factors of decending thoracic aortic dilatation after TEVAR of DeBakey IIIb-AD; while cumulative size of residual intimal tears on abdominal aorta
’
JVIR
was the only independent risk factor of postoperative abdominal aortic dilatation. References 1. Fattori R, Cao P, De Rango P, Czerny M, Evangelista A, Nienaber C, et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J AM COLL CARDIOL. 2013;61ı¨ ¼sˇ 1661-78. 2. Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). EUR HEART J. 2014;35ı¨ ¼sˇ 2873-926. 3. Goldfinger JZ, Halperin JL, Marin ML, Stewart AS, Eagle KA, Fuster V. Thoracic aortic aneurysm and dissection. J AM COLL CARDIOL. 2014;64ı¨ ¼sˇ 1725-39. 4. Singh M, Hager E, Avgerinos E, Genovese E, Mapara K, Makaroun M. Choosing the correct treatment for acute aortic type B dissection. J Cardiovasc Surg (Torino). 2015;56ı¨ ¼sˇ 217-29.
4:03 PM
Abstract No. 254
Predictors of late false lumen enlargement after thoracic stent-graft placement for type-B aortic dissection A. Gasparetto1, K. Park2, S. Sabri3, A. Park4, A. Matsumoto5, J. Angle3; 1University of Virginia, Baltimore, MD; 2Samsung Medical Center, Sungkyunkwan University School, Seoul, Republic of Korea; 3Charlottesville, VA; 4UVA Health System, Charlottesville, VA; 5University of Virginia Health System, Charlottesville, VA. Purpose: To evaluate anatomic factors related to delayed aortic outer diameter (OD) and false lumen (FL) enlargement in patients undergoing thoracic stent graft placement for Type-B aortic dissection. Materials: A retrospective review of thoracic endovascular aortic repair (TEVAR) for type-B aortic dissection between January 2005 and May 2015 at a single institution was performed. Pre- and post-procedure CTA were analyzed for false lumen (FL) diameter, aortic outer diameter (OD) and sources of persistent FL filling after endograft placement. Imaging and clinical variables were assessed through univariate analysis to study their relationship with FL enlargement. Results: Sixty-two patients (45 males and 17 females) aged 26 to 80 years old (mean age: 58.1) were identified. Follow up period ranged from 3 to 104 months (mean 27.1 months). FL or OD increased more than 5mm in 12/62 patients (19.4%) and 10/12 underwent re-intervention (po.001). Patients featuring multiple types of inflow into the FL after endograft placement had increased risk of FL or OD enlargement (p¼.003) while patients with complete FL thrombosis were less likely to present with FL or OD enlargement (po.001). Conclusions: Spontaneous FL thrombosis is the best predictor of FL and aortic growth. Early intervention to decrease the number of FL flow sources after endograft placement for type B dissection may help prevent expansion of the FL and reduce the need for late reinterventions.