Key result
Stent-graft repair for complicated TBAD carries a ~59% endoleak rate, linked to left subclavian artery coverage.
Why the study?
What anatomic and clinical factors are associated with endoleak formation after thoracic aortic stent-graft repair of complicated type B aortic dissections?
Cohort (n=37)
What anatomic and clinical factors are associated with endoleak formation after thoracic aortic stent-graft repair of complicated type B aortic dissections?
Endoleaks are common after stent-graft repair of complicated type B aortic dissections and are strongly associated with anatomic complexities such as acute aortic curvature and covered side branches, highlighting the need for dissection-specific devices.
Endoleak risk in complex anatomy may warrant intensified surveillance; leaves open whether dissection-specific devices improve outcomes in trials.
BACKGROUND: Endoleaks after stent-graft repair of aortic dissections are poorly understood but seem substantially different from those seen after aneurysm repair. We studied anatomic and clinical factors associated with endoleaks in patients who underwent stent-graft repair of complicated type B aortic dissections. METHODS AND RESULTS: From 2000 to 2007, 37 patients underwent stent-graft repair of acute (< or =14 days; n=23), subacute (15 to 90 days; n=10) or chronic (>90 days; n=4) complicated type B aortic dissections using the Gore Thoracic Excluder (n=17) or TAG stent-grafts (n=20) under an investigator-sponsored protocol. Endoleaks were classified as imperfect proximal seal, flow through fenestrations or branches, or complex (both). Variables studied included coverage of the left subclavian artery, aortic curvature, completeness of proximal apposition, dissection chronicity, and device used. Endoleaks were found during follow-up (mean, 22 months) in 59% of patients, and they were associated with coverage of the left subclavian artery (complex, P<0.001), small radius of curvature (type 1 and complex, P=0.05), and greatest length of unapposed proximal stent graft (complex, P<0.0001). During follow-up, 10 endoleaks resolved spontaneously, 6 required reintervention for false lumen dilatation, and 2 were stable without clinical consequences. CONCLUSIONS: Endoleaks are common after stent-graft repair of aortic dissection and may lead to false lumen enlargement necessitating reintervention. Anatomic complexities such as acute aortic curvature and covered side branches were associated with endoleaks, illustrating the need for dissection-specific device development.
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Sze et al. (2009) conducted a cohort in complicated type B aortic dissections (n=37). Anatomic complexities (left subclavian artery coverage, small radius of curvature, unapposed proximal stent graft length) was evaluated on Endoleak formation. Endoleaks occurred in 59% of patients after stent-graft repair of complicated type B aortic dissection and were significantly associated with anatomic complexities like left subclavian artery coverage.
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