1. Aggressive Treatment Strategy at Index Thoracic Endovascular Aortic Surgery is Associated with Reduced Need for Short-Term Reintervention in Patients with Aortic Dissection.
- Author
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Amedi A, Meena RA, Garcia-Toca M, Ramos CR, Benarroch-Gampel J, H'Doubler PB, Duwayri Y, Leshnower BG, and Rajani RR
- Subjects
- Humans, Female, Middle Aged, Male, Retrospective Studies, Time Factors, Risk Factors, Treatment Outcome, Aged, Blood Vessel Prosthesis, Postoperative Complications etiology, Risk Assessment, Adult, Aortic Dissection surgery, Aortic Dissection diagnostic imaging, Endovascular Procedures adverse effects, Blood Vessel Prosthesis Implantation adverse effects, Aortic Aneurysm, Thoracic surgery, Aortic Aneurysm, Thoracic diagnostic imaging, Stents, Reoperation
- Abstract
Introduction: Thoracic endovascular aortic surgery (TEVAR) is the modern standard of treatment for patients with Type B aortic dissection, however it is unclear how the initial length of treated aorta affects long-term outcomes. This study aims to elucidate risk factors for secondary intervention after TEVAR for aortic dissection, focusing on length of aortic treatment at index operation., Methods: A retrospective multihospital chart review was completed for patients treated between 2011 and 2022 who underwent TEVAR for aortic dissection with at least 1 year of post-TEVAR imaging and follow-up. Patient demographics and characteristics were analyzed. In this study, aortic zones treated only included those managed with a covered stent graft. The primary outcome measure was any need for secondary intervention., Results: A total of 151 patients were identified. Demographics included a mean age of 57 years, with 31.8% of the patients being female. Forty-three patients (28.5%) underwent secondary intervention after TEVAR, with a mean follow-up of 1.6 years. The most common indication for secondary intervention was aneurysmal degeneration of the residual false lumen (76%). There was a significant difference in the number of aortic zones treated in patients who did and did not require secondary intervention (2.3 ± 1 vs. 2.7 ± 1, P = 0.04). Additionally, patients with 3 or more aortic zones of treatment had a significant difference in the need for reintervention (32% secondary intervention versus 52% no secondary intervention, P = 0.02)., Conclusions: At least 3 zones of aortic treatment at index TEVAR is associated with a decreased need for overall reintervention. Modern treatment of acute and subacute type B dissection should stress an aggressive initial repair, balanced by the potential increased risk of spinal cord ischemia., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
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