Factors portending endoleak formation after thoracic aortic stent-graft repair of complicated aortic dissection

Daniel Y. Sze, Maurice A A J Van Den Bosch, Michael D. Dake, D. Craig Miller, Lawrence V. Hofmann, Robin Varghese, S. Chris Malaisrie, Pieter J A Van Der Starre, Jarrett Rosenberg, R. Scott Mitchell

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

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 (<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. (Circ Cardiovasc Intervent. 2009;2:105-112.)

Original languageEnglish (US)
Pages (from-to)105-112
Number of pages8
JournalCirculation: Cardiovascular Interventions
Volume2
Issue number2
DOIs
StatePublished - Apr 1 2009

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Endoleak
Stents
Dissection
Thorax
Transplants
Subclavian Artery
Equipment and Supplies
Aneurysm
Dilatation
Research Personnel

Keywords

  • Aorta
  • Complications
  • Dissection
  • Surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Sze, D. Y., Van Den Bosch, M. A. A. J., Dake, M. D., Miller, D. C., Hofmann, L. V., Varghese, R., ... Mitchell, R. S. (2009). Factors portending endoleak formation after thoracic aortic stent-graft repair of complicated aortic dissection. Circulation: Cardiovascular Interventions, 2(2), 105-112. https://doi.org/10.1161/CIRCINTERVENTIONS.108.819722
Sze, Daniel Y. ; Van Den Bosch, Maurice A A J ; Dake, Michael D. ; Miller, D. Craig ; Hofmann, Lawrence V. ; Varghese, Robin ; Malaisrie, S. Chris ; Van Der Starre, Pieter J A ; Rosenberg, Jarrett ; Mitchell, R. Scott. / Factors portending endoleak formation after thoracic aortic stent-graft repair of complicated aortic dissection. In: Circulation: Cardiovascular Interventions. 2009 ; Vol. 2, No. 2. pp. 105-112.
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Sze, DY, Van Den Bosch, MAAJ, Dake, MD, Miller, DC, Hofmann, LV, Varghese, R, Malaisrie, SC, Van Der Starre, PJA, Rosenberg, J & Mitchell, RS 2009, 'Factors portending endoleak formation after thoracic aortic stent-graft repair of complicated aortic dissection', Circulation: Cardiovascular Interventions, vol. 2, no. 2, pp. 105-112. https://doi.org/10.1161/CIRCINTERVENTIONS.108.819722

Factors portending endoleak formation after thoracic aortic stent-graft repair of complicated aortic dissection. / Sze, Daniel Y.; Van Den Bosch, Maurice A A J; Dake, Michael D.; Miller, D. Craig; Hofmann, Lawrence V.; Varghese, Robin; Malaisrie, S. Chris; Van Der Starre, Pieter J A; Rosenberg, Jarrett; Mitchell, R. Scott.

In: Circulation: Cardiovascular Interventions, Vol. 2, No. 2, 01.04.2009, p. 105-112.

Research output: Contribution to journalArticle

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T1 - Factors portending endoleak formation after thoracic aortic stent-graft repair of complicated aortic dissection

AU - Sze, Daniel Y.

AU - Van Den Bosch, Maurice A A J

AU - Dake, Michael D.

AU - Miller, D. Craig

AU - Hofmann, Lawrence V.

AU - Varghese, Robin

AU - Malaisrie, S. Chris

AU - Van Der Starre, Pieter J A

AU - Rosenberg, Jarrett

AU - Mitchell, R. Scott

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N2 - 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 (<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. (Circ Cardiovasc Intervent. 2009;2:105-112.)

AB - 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 (<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. (Circ Cardiovasc Intervent. 2009;2:105-112.)

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KW - Complications

KW - Dissection

KW - Surgery

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