Inducing false lumen thrombosis for retrograde type A aortic dissection

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• 作者：Rongjie Zhang ; MD ; Jian Zhou ; MD ; Jiaxuan Feng ; MD ; Zhiqing Zhao ; MD ; Junjun Liu ; MD ; Zhenjiang Li ; MD ; Rui Feng ; MD ; ^{fengrui1588@qq.com} ; Zaiping Jing ; MD ; PhD ; ^{xueguanky@163.com}
• 关键词：aortic dissection ; coil ; onyx glue ; retrograde ; TEVAR
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：153
• 期：1
• 页码：57-65
• 全文大小：2542 K
• 卷排序：153

文摘

How to choose the proximal landing zone in endovascular interventions for a patient with a patent retrograde false lumen in dissection of the ascending aorta and aortic arch remains unclear. This study sought to report the safety and efficiency of inducing thrombosis of the retrograde false lumen to enhance a proximal landing zone to treat retrograde type A aortic dissection.MethodsThis study included 9 patients with retrograde type A aortic dissection treated with a 2-stage operation strategy between January 2015 and January 2016. Coil and Onyx glue embolization was performed to create a thrombogenic environment in the retrograde false lumen of the ascending aorta and aortic arch as the first-stage operation, followed by thoracic endovascular aortic repair (TEVAR) with the chimney technique as the second-stage operation.ResultsComplete thrombosis in a retrograde false lumen of the ascending aorta and aortic arch was found in all 9 patients before the second-stage operation was performed. The rate of successful TEVAR was 100%, with the single-chimney technique performed in 6 patients to reconstruct the left subclavian artery and the double-chimney technique performed in 3 patients to reconstruct the left common carotid artery. No morbidities, no stent graft–induced new dissection, or deaths occurred in the hospital and during the 12-month follow-up period. Positive morphological remodeling was evidenced in all cases.ConclusionsThe short-term outcomes of the patients in this study were satisfactory. Inducing thrombosis of the retrograde false lumen to enhance the proximal landing zone for TEVAR may be a safe and effective approach to treating retrograde type A aortic dissection.