Top

Indian Journal of Thoracic and Cardiovascular Surgery

Published in:

Open Access 01-04-2022 | Aortic Dissection | Review Article

Alternative management of proximal aortic dissection: concept and application

Authors: Xun Yuan, Andreas Mitsis, David Mozalbat, Christoph A. Nienaber

Published in: Indian Journal of Thoracic and Cardiovascular Surgery | Special Issue 1/2022

Abstract

Open surgery remains the mainstay of treatment for acute type A aortic dissection and should be offered to most patients. However, there are elderly patients in which surgical treatment may be deemed extremely high risk or futile. Endovascular treatment approaches have been applied to a small number of these patients and data are limited to case reports and small series. The application of endovascular therapies to ascending aorta is currently limited by anatomical and technical challenges posed by the dynamic motion of the ascending aorta and the proximity of vital structures to intended landing zones (aortic valve, coronary arteries, and supra-aortic branches) and lack of specially designed endografts to address these issues. While thoracic endovascular aortic repair (TEVAR) has replaced open aortic repair for a suitable lesion in distal aortic dissection, some selected patients with type A aortic dissection at high surgical may be candidates. Hence, there is potential because, in proximal (Stanford type A) dissections, 10–30% of patients are not accepted for surgery, and 30–50% are technically amenable for TEVAR. Recent experience has shown that carefully selected patients with favorable anatomical characteristics may be subject to endovascular stent-graft treatment as a last resort with mixed results. Technical improvement is necessary to offer. satisfactory endovascular options in non-surgical candidates.

Trimarchi S, Nienaber CA, Rampoldi V, et al. Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience. J Thorac Cardiovasc Surg. 2005;129:112–22.PubMedCrossRef

Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection: perspectives from the International Registry of Acute Aortic Dissection (IRAD). Eur J Vasc Endovasc Surg. 2009;37:149–59.PubMedCrossRef

Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection. J Am Coll Cardiol. 2015;66:350–8.PubMedCrossRef

Trimarchi S, Eagle KA, Nienaber CA, et al. Role of age in acute type A aortic dissection outcome: report from the International Registry of Acute Aortic Dissection (IRAD). J Thorac Cardiovasc Surg. 2010;140:784–9.PubMedCrossRef

Sobocinski J, O’Brien N, Maurel B, et al. Endovascular approaches to acute aortic type A dissection: a CT-based feasibility study. Eur J Vasc Endovasc Surg. 2011;42:442–7.PubMedCrossRef

Ihnken K, Sze D, Dake MD, Fleischmann D, Van der Starre P, Robbins R. Successful treatment of a Stanford type A dissection by percutaneous placement of a covered stent graft in the ascending aorta. J Thorac Cardiovasc Surg. 2004;127:1808–10.PubMedCrossRef

Ye C, Chang G, Li S, et al. Endovascular stent-graft treatment for Stanford type A aortic dissection. Eur J Vasc Endovasc Surg. 2011;42:787–94.PubMedCrossRef

Vallabhajosyula P, Gottret J-P, Bavaria JE, Desai ND, Szeto WY. Endovascular repair of the ascending aorta in patients at high risk for open repair. J Thorac Cardiovasc Surg. 2015;149:S144–50.

Nienaber CA, Kische S, Rehders TC, et al. Rapid pacing for better placing: comparison of techniques for precise deployment of endografts in the thoracic aorta. J Endovasc Ther. 2007;14:506–12.PubMedCrossRef

10.

Bossone E, Evangelista A, Isselbacher E, et al. Prognostic role of transesophageal echocardiography in acute type A aortic dissection. Am Heart J. 2007;153:1013–20.PubMedCrossRef

11.

Nienaber CA, Sakalihasan N, Clough RE, et al. Thoracic endovascular aortic repair (TEVAR) in proximal (type A) aortic dissection: Ready for a broader application? J Thorac Cardiovasc Surg. 2017;153:S3–S11.

12.

Koschyk DH, Nienaber CA, Knap M, et al. How to guide stent-graft implantation in type B aortic dissection? Comparison of angiography, transesophageal echocardiography, and intravascular ultrasound. Circulation. 2005;112:I260–4.

13.

Moon MC, Greenberg RK, Morales JP, et al. Computed tomography-based anatomic characterization of proximal aortic dissection with consideration for endovascular candidacy. J Vasc Surg. 2011;53:942–9.PubMedCrossRef

14.

Roselli EE, Idrees J, Greenberg RK, Johnston DR, Lytle BW. Endovascular stent grafting for ascending aorta repair in high-risk patients. J Thorac Cardiovasc Surg. 2015;149:144–51.PubMedCrossRef

15.

Khoynezhad A, White RA, Koopmann MC, Kopchok GE, Walot I, Donayre CE. Ascending Aortic Endovascular Repair (AA EVR): Results of FDA-approved PS-IDE feasibility study. J Vasc Surg. 2015;62:529–30.CrossRef

16.

Rampoldi V, Trimarchi S, Eagle KA, et al. Simple risk models to predict surgical mortality in acute type A aortic dissection: the International Registry of Acute Aortic Dissection score. Ann Thorac Surg. 2007;83:55–61.PubMedCrossRef

17.

Diethrich EB, Ghazoul M, Wheatley GH, et al. Surgical correction of ascending type A thoracic aortic dissection: simultaneous endoluminal exclusion of the arch and distal aorta. J Endovasc Ther. 2005;12:660–6.PubMedCrossRef

18.

Dobrilovic N ,Elefteriades JA. Stenting the descending aorta during repair of type A dissection: technology looking for an application? J Thorac Cardiovasc Surg. 2006;131:777–8.

19.

Ueda T, Fleischmann D, Dake MD, Rubin GD, Sze DY. Incomplete endograft apposition to the aortic arch: bird-beak configuration increases risk of endoleak formation after thoracic endovascular aortic repair. Radiology. 2010;255:645–52.PubMedCrossRef

20.

Metcalfe MJ, Karthikesalingam A, Black SA, Loftus IM, Morgan R, Thompson MM. The first endovascular repair of an acute type A dissection using an endograft designed for the ascending aorta. J Vasc Surg. 2012;55:220–2.PubMedCrossRef

21.

Lu Q, Feng J, Zhou J, et al. Endovascular repair of ascending aortic dissection: a novel treatment option for patients judged unfit for direct surgical repair. J Am Coll Cardiol. 2013;61:1917–24.PubMedCrossRef

22.

Ronchey S, Serrao E, Alberti V, et al. Endovascular stenting of the ascending aorta for type A aortic dissections in patients at high risk for open surgery. Eur J Vasc Endovasc Surg. 2013;45:475–80.PubMedCrossRef

23.

Nienaber CA, Fattori R, Lund G, et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med. 1999;340:1539–45.PubMedCrossRef

24.

Dake MD, Kato N, Mitchell RS, et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med. 1999;340:1546–52.PubMedCrossRef

25.

Wang ZG, Massimo CG, Li M, et al. Deployment of endograft in the ascending aorta to reverse type A aortic dissection. Asian J Surg. 2003;26:117–9.PubMedCrossRef

26.

Zhang H, Li M, Jin W, Wang Z. Endoluminal and surgical treatment for the management of Stanford Type A aortic dissection. Eur J Cardiothorac Surg. 2004;26:857–9.PubMedCrossRef

27.

Zimpfer D, Czerny M, Kettenbach J, et al. Treatment of acute type A dissection by percutaneous endovascular stent-graft placement. Ann Thorac Surg. 2006;82:747–9.

28.

Comas GM, Leshnower BG, Halkos ME, et al. Acute type A dissection: impact of antegrade cerebral perfusion under moderate hypothermia. Ann Thorac Surg. 2013;96:2135–41.PubMedCrossRef

29.

Tsai TT, Evangelista A, Nienaber CA, et al. Partial thrombosis of the false lumen in patients with acute type B aortic dissection. N Engl J Med. 2007;357:349–59.PubMedCrossRef

30.

Kim T-H, Song S-W, Lee K-H, Baek M-Y, Yoo K-J. Effects of false lumen procedures on aorta remodeling of chronic DeBakey IIIb aneurysm. Ann Thorac Surg. 2016;102:1941–7.PubMedCrossRef

31.

Gysi J, Schaffner T, Mohacsi P, Aeschbacher B, Althaus U, Carrel T. Early and late outcome of operated and non-operated acute dissection of the descending aorta. Eur J Cardiothorac Surg. 1997;11:1163–9.

32.

Haverich A, Miller DC, Scott WC, et al. Acute and chronic aortic dissections--determinants of long-term outcome for operative survivors. Circulation. 1985;72:II22–34.

33.

Umana JP, Lai DT, Mitchell RS, et al. Is medical therapy still the optimal treatment strategy for patients with acute type B aortic dissections? J Thorac Cardiovasc Surg. 2002;124:896–910.PubMedCrossRef

34.

Bernard Y, Zimmermann H, Chocron S, et al. False lumen patency as a predictor of late outcome in aortic dissection. Am J Cardiol. 2001;87:1378–82.PubMedCrossRef

35.

Oikonomou K, Katsargyris A, Ritter W, Spinelli D, Seto Y, Verhoeven EL. Endovascular management of chronic post-dissection aneurysms. Ann Cardiothorac Surg. 2014;3:307–13.PubMedPubMedCentral

36.

Roselli EE, Sepulveda E, Pujara AC, Idrees J, Nowicki E. Distal landing zone open fenestration facilitates endovascular elephant trunk completion and false lumen thrombosis. Ann Thorac Surg. 2011;92:2078–84.PubMedCrossRef

37.

Kolbel T, Lohrenz C, Kieback A, Diener H, Debus ES, Larena-Avellaneda A. Distal false lumen occlusion in aortic dissection with a homemade extra-large vascular plug: the candy-plug technique. J Endovasc Ther. 2013;20:484–9.PubMedCrossRef

38.

Marone EM, Leopardi M, Bertoglio L, Mascia D, Chiesa R. Original off-label endovascular solution to occlude false lumen rupture in chronic type B aortic dissection. Ann Vasc Surg. 2017;40:299 e1–299 e5.

39.

Van den Eynde W, Verbist J. A growing type I TAAA after treatment with a multilayer stent. Eur J Vasc Endovasc Surg. 2017;54:438.PubMedCrossRef

40.

Ke K, Zheng H, Yang W. Is multilayer bare stent safe or effective for the treatment of aortic aneurysms? A meta-analysis with early and mid-term outcomes. Ann Vasc Surg. 2017;40:112–9.PubMedCrossRef

41.

Wojtaszek M, Wnuk E, Maciag R, Lamparski K, Korzeniowski K, Rowinski O. Promoting false-lumen thrombosis after thoracic endovascular aneurysm repair in type B aortic dissection by selectively excluding false-lumen distal entry tears. J Vasc Interv Radiol. 2017;28:168–75.PubMedCrossRef

42.

Hofferberth SC, Nixon IK, Mossop PJ. Aortic false lumen thrombosis induction by embolotherapy (AFTER) following endovascular repair of aortic dissection. J Endovasc Ther. 2012;19:538–45.PubMedCrossRef

43.

Yuan X, Mitsis A, Mozalbat D, Nienaber CA. Novel endovascular management of proximal type A (DeBakey II) aortic dissection with a patent foramen ovale occluder. J Endovasc Ther. 2017;24:809–13.PubMedCrossRef

44.

Henrikson O, Roos H, Falkenberg M. Ethylene vinyl alcohol copolymer (Onyx) to seal type 1 endoleak A new technique. Vascular. 2011;19:77–81.PubMedCrossRef

45.

Marcelin C, Le Bras Y, Petitpierre F, et al. Safety and efficacy of embolization using Onyx((R)) of persistent type II endoleaks after abdominal endovascular aneurysm repair. Diagn Interv Imaging. 2017;98:491–7.PubMedCrossRef

46.

Clough RE, Nienaber CA. Evidence for and risks of endovascular treatment of asymptomatic acute type B aortic dissection. J Cardiovasc Surg. 2017;58:270–7.CrossRef

47.

Sailer AM, van Kuijk SMJ, Nelemans PJ, et al. Computed tomography imaging features in acute uncomplicated stanford Type-B aortic dissection predict late adverse events. Circ Cardiovasc Imaging. 2017;10:e005709.

48.

Kolbel T, Reiter B, Schirmer J, Wipper S, Detter C, Debus ES, Reichenspurner H. Customized transapical thoracic endovascular repair for acute type A dissection. Ann Thorac Surg. 2013;95:694–6.PubMedCrossRef

49.

Luo C-M, Wang S-S, Chi N-H, Wu I-H. Transapical endovascular repair with a table-tailored endograft to treat ascending aortic dissection. J Card Surg. 2014;29:824–6.

50.

Guo W, Liu X, Liang F, et al. Transcarotid artery endovascular reconstruction of the aortic arch by modified bifurcated stent graft for Stanford type A dissection. Asian J Surg. 2007;30:290–5.PubMedCrossRef

51.

Mangialardi N, Ronchey S, Malaj A, et al. Case report of an endovascular repair of a residual type A dissection using a not CE not FDA-approved Najuta thoracic stent graft system. Medicine (Baltimore). 2015;94:e436.

52.

Sabik JF, Lytle BW, McCarthy PM, Cosgrove DM. Axillary artery: an alternative site of arterial cannulation for patients with extensive aortic and peripheral vascular disease. J Thorac Cardiovasc Surg. 1995;109:885–90.

53.

Berretta P, Patel HJ, Gleason TG, et al. IRAD experience on surgical type A acute dissection patients: results and predictors of mortality. Ann Cardiothorac Surg. 2016;5:346–51.PubMedPubMedCentralCrossRef

54.

Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000;283:897–903.PubMedCrossRef

55.

Geisbusch P, Hoffmann S, Kotelis D, Able T, Hyhlik-Durr A, Bockler D. Reinterventions during midterm follow-up after endovascular treatment of thoracic aortic disease. J Vasc Surg. 2011;53:1528–33.PubMedCrossRef

56.

Ongstad SB, Miller DF, Panneton JM. The use of EndoAnchors to rescue complicated TEVAR procedures. J Cardiovasc Surg. 2016;57:716–29.

57.

Menon RS, Muetterties C, Moser GW, Wheatley GH 3rd. Endoanchor stenting for the repair of a type I endoleak in the aortic arch following the endovascular repair of a Kommerrell’s diverticulum. J Card Surg. 2016;31:541–3.PubMedCrossRef

58.

Tse LW, Lindsay TF, Roche-Nagle G, Oreopoulos GD, Ouzounian M, Tan KT. Radiofrequency in situ fenestration for aortic arch vessels during thoracic endovascular repair. J Endovasc Ther. 2015;22:116–21.PubMedCrossRef

59.

Li Z, Lu Q, Feng R, et al. Outcomes of endovascular repair of ascending aortic dissection in patients unsuitable for direct surgical repair. J Am Coll Cardiol. 2016;68:1944–54.PubMedCrossRef

Title: Alternative management of proximal aortic dissection: concept and application
Authors: Xun Yuan
Andreas Mitsis
David Mozalbat
Christoph A. Nienaber
Publication date: 01-04-2022
Publisher: Springer Singapore
Keyword: Aortic Dissection
Published in: Indian Journal of Thoracic and Cardiovascular Surgery / Issue Special Issue 1/2022
Print ISSN: 0970-9134
Electronic ISSN: 0973-7723
DOI: https://doi.org/10.1007/s12055-021-01281-3

At a glance: The STEP trials

Springer Medicine

Alternative management of proximal aortic dissection: concept and application

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Special Issue 1/2022

“Why is frozen elephant trunk better than classical elephant trunk?”

Malperfusion in acute type A aortic dissection: how we handle the challenge?

Genetic screening in heritable thoracic aortic disease—rationale, potentials and pitfalls

Tips and tricks in redo aortic ﻿surgery

Minimally invasive approach: is this the future of aortic surgery?

Frozen elephant trunk in acute type A aortic dissections: frontiers and challenges

Tips and tricks in redo aortic surgery