Endovascular repair for retrograde type A intramural hematoma with focal intimal disruption in descending aorta

Journal of Thoracic Disease

article

Jiehua Li¹  Xiaolong Zhang¹  Yuan Peng¹  Lunchang Wang¹  Tun Wang¹  Xin Li¹  Hao He¹  Quanming Li¹  Chang Shu¹ 

[1] Department of Vascular Surgery, the Second Xiangya Hospital, Central South University;Vascular Disease Institute, Central South University;Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College

关键词: Thoracic endovascular aortic repair (TEVAR);    retrograde type A intramural hematoma (retrograde type A IMH);    focal intimal disruption (FID);    aortic stent graft;   

DOI  :  10.21037/jtd-21-574

学科分类：呼吸医学

来源: Pioneer Bioscience Publishing Company

【 摘 要 】

Background: This study aims to report the experience of a single center using thoracic endovascular aortic repair (TEVAR) to treat retrograde type A intramural hematoma (IMH) with focal intimal disruption (FID) in descending aorta.Methods: A total of 24 consecutive patients with retrograde type A IMH and complicated with FID in descending aorta underwent TEVAR in our center from 2015 to 2020. Their clinical data, imaging manifestation and follow-up results were retrospectively reviewed and analyzed.Results: The median age of patients was 57.9 years (range, 42–80 years) and 18 were men (75%). As the preoperative CT angiography showed, the 24 patients developed IMH complicated with different kinds of FIDs in descending aorta [5 had intramural blood pool (IBP), 15 had ulcer-like projection (ULP), 2 had penetrating atherosclerotic ulcer (PAU), and 5 had localized dissection]. Successful deployment of aortic stent graft was achieved in all patients. There was no endoleak, stent graft migration, spinal cord ischemia, stroke, or 30-day mortality observed after TEVAR. The median duration of follow-up was 30.0 months (range, 3–60 months). As the last follow-up CT angiography showed, most of the patients (23 in 24, 96%) had favorable aortic remodeling. The maximum hematoma thicknesses and maximum diameters of both ascending and descending aorta were significantly decreased. During follow-up, 1 patient developed retrograde type A aortic dissection (RAAD) and underwent open surgery 3 months after TEVAR. 1 patient died of lung cancer 2 years later. There was no aorta-related death observed.Conclusions: TEVAR provides a safe and effective treatment strategy for selected patients with retrograde type A IMH, and FID developed in descending aorta could be the possible treatment target. However, RAAD remains one of the most serious postoperative complications of concern.

【 授权许可】

Unknown