Causes and Risk Factors of Multiple-interventions in Endovascular Repair for Aortic Dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHENKai , JINGZai-ping , ZHANGLei ,  ZHOUJian

Department of Vascular Surgery of Changhai Hospital, Shanghai 200433, P.R.China;

Corresponding author：

ZHOUJian, Email: zhoujian1-2@163.com

Keywords：

Multiple-intervention; Aortic dissection; Endovascular repair

DOI：

10.7507/1007-4848.20160101

Video：

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Objective To assess the causes and risk factors of multiple-intervention in endovascular aortic repair (EVAR) for type B aortic dissection (TBAD). Methods We retrospectively analyzed the clinical data of 347 TBAD patients initially treated with EVAR in our hospital between January 1999 and December 2013. The patients were stratified into a multiple-intervention group (34 patients) and a single-intervention group (313 patients). We analyzed the differences of clinical data of the two groups. Results There were 9 patients with endoleak, 10 patients with new dissection, 8 patients with incomplete thrombosis of the false lumen, 4 patients with new aneurysm, 2 patients with retrograde dissection, and 1 patient with iliac artery occlusion in the multiple-intervention group. Higher proportions of chronic dissection and smoking occurred in the multiple-intervention group (79.4% versus 50.8%, 61.8% versus 40.3%, P=0.002, 0.018, respectively). Both of the degree and proportion of hyperglycemia were higher in the multiple-intervention group (6.9±2.3 mmol/L versus 5.7±1.8 mmol/L, P=0.027; 44.1% versus 22.7%, P=0.011). There were statistical differences in oversizing rate of grafts (14.6%±3.2% versus 11.3%±2.5%, P<0.001), operation time (172 min versus 82 min, P<0.001), and blood loss (280 ml versus 100 ml, P=0.006) between the two groups. Conclusion Endoleak, new dissection, and incomplete thrombosis of the false lumen are the main causes of multiple-intervention. While in chronic phase, smoking, hyperglycemia, too big oversizing, and complicated lesion or operation are the potential risk factors.

Citation： CHENKai, JINGZai-ping, ZHANGLei, ZHOUJian. Causes and Risk Factors of Multiple-interventions in Endovascular Repair for Aortic Dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(5): 425-429. doi: 10.7507/1007-4848.20160101 Copy

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2.	Olsson C, Thelin S, Stahle E, et al. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002. Circulation, 2006, 114(24): 2611-2618.
3.	Patterson B, Holt P, Nienaber C, et al. Aortic pathology determines midterm outcome after endovascular repair of the thoracic aorta: report from the Medtronic Thoracic Endovascular Registry (MOTHER) database. Circulation, 2013, 127(1): 24-32.
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5.	Hanna JM, Andersen ND, Ganapathi AM, et al. Five-year results for endovascular repair of acute complicated type B aortic dissection. J Vasc Surg, 2014, 59(1): 96-106.
6.	Zeeshan A, Woo EY, Bavaria JE, et al. Thoracic endovascular aortic repair for acute complicated type B aortic dissection: superiority relative to conventional open surgical and medical therapy. J Thorac Cardiovasc Surg, 2010, 140(6 Suppl): S109-115; discussion S142-S146.
7.	王雪钢, 白斗, 武少辉, 等. Stanford B型主动脉夹层胸主动脉腔内修复术术后内脏动脉血供改善情况分析. 中国胸心血管外科临床杂志, 2015, 22(2): 143-145.
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9.	Eggebrecht H, Nienaber CA, Neuhauser M, et al. Endovascular stent-graft placement in aortic dissection: a meta-analysis. Eur Heart J, 2006, 27(4): 489-498.
10.	Steuer J, Eriksson MO, Nyman R, et al. Early and long-term outcome after thoracic endovascular aortic repair (TEVAR) for acute complicated type B aortic dissection. Eur J Vasc Endovasc Surg, 2011, 41(3): 318-323.
11.	Garbade J, Jenniches M, Borger MA, et al. Outcome of patients suffering from acute type B aortic dissection: a retrospective single-centre analysis of 135 consecutive patients. Eur J Cardiothorac Surg, 2010, 38(3): 285-292.
12.	Shah AA, Barfield ME, Andersen ND, et al. Results of thoracic endovascular aortic repair 6 years after United States Food and Drug Administration approval. Ann Thorac Surg, 2012, 94(5): 1394-1399.
13.	Kato N, Hirano T, Kawaguchi T, et al. Aneurysmal degeneration of the aorta after stent-graft repair of acute aortic dissection. J Vasc Surg, 2001, 34(3): 513-518.
14.	Nauta FJ, Conti M, Kamman AV, et al. Biomechanical changes after thoracic endovascular aortic repair in type b dissection: a systematic review. J Endovasc Ther, 2015, 22(6): 918-933.
15.	Sueyoshi E, Sakamoto I, Hayashi K, et al. Growth rate of aortic diameter in patients with type B aortic dissection during the chronic phase. Circulation, 2004, 110(11 Suppl 1): II256-261.
16.	Parodi JC, Berguer R, Ferreira LM, et al. Intra-aneurysmal pressure after incomplete endovascular exclusion. J Vasc Surg, 2001, 34(5): 909-914.
17.	Chung JW, Elkins C, Sakai T, et al. True-lumen collapse in aortic dissection: part I. Evaluation of causative factors in phantoms with pulsatile flow. Radiology, 2000, 214(1): 87-98.
18.	Kusagawa H, Shimono T, Ishida M, et al. Changes in false lumen after transluminal stent-graft placement in aortic dissections: six years' experience. Circulation, 2005, 111(22): 2951-2957.
19.	Tsukube T, Hayashi T, Kawahira T, et al. Neurological outcomes after immediate aortic repair for acute type A aortic dissection complicated by coma. Circulation, 2011, 124(11 Suppl): S163-167.
20.	Virtue Registry Investigators. The VIRTUE Registry of type B thoracic dissections--study design and early results. Eur J Vasc Endovasc Surg, 2011, 41(2): 159-166.
21.	Virtue Registry Investigators. Mid-term outcomes and aortic remodelling after thoracic endovascular repair for acute, subacute, and chronic aortic dissection: the VIRTUE Registry. Eur J Vasc Endovasc Surg, 2014, 48(4): 363-371.
22.	Takeuchi T, Adachi H, Ohuchida M, et al. A case-control study found that low albumin and smoking were associated with aortic dissection. J Clin Epidemiol, 2004, 57(4): 386-391.
23.	Kakafika AI, Mikhailidis DP. Smoking and aortic diseases. Circ J, 2007, 71(8): 1173-1180.
24.	He X, Liu X, Liu W, et al. Association between diabetes and risk of aortic dissection: a case-control study in a Chinese population. PLoS One, 2015, 10(11): e0142697.
25.	Nienaber CA. Diabetes mellitus and thoracic aortic disease: are people with diabetes mellitus protected from acute aortic dissection? J Am Heart Assoc, 2012, 1(3): e001404.
26.	Dua MM, Miyama N, Azuma J, et al. Hyperglycemia modulates plasminogen activator inhibitor-1 expression and aortic diameter in experimental aortic aneurysm disease. Surgery, 2010, 148(2): 429-435.
27.	Astrand H, Ryden-Ahlgren A, Sundkvist G, et al. Reduced aortic wall stress in diabetes mellitus. Eur J Vasc Endovasc Surg, 2007, 33(5): 592-598.
28.	Feng J, Lu Q, Zhao Z, et al. Restrictive bare stent for prevention of stent graft-induced distal redissection after thoracic endovascular aortic repair for type B aortic dissection. J Vasc Surg, 2013, 57(2 Suppl): 44S-52S.

1. Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet, 2015, 385(9970): 800-811.
2. Olsson C, Thelin S, Stahle E, et al. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002. Circulation, 2006, 114(24): 2611-2618.
3. Patterson B, Holt P, Nienaber C, et al. Aortic pathology determines midterm outcome after endovascular repair of the thoracic aorta: report from the Medtronic Thoracic Endovascular Registry (MOTHER) database. Circulation, 2013, 127(1): 24-32.
4. Luebke T, Brunkwall J. Outcome of patients with open and endovascular repair in acute complicated type B aortic dissection: a systematic review and meta-analysis of case series and comparative studies. J Cardiovasc Surg (Torino), 2010, 51(5): 613-632.
5. Hanna JM, Andersen ND, Ganapathi AM, et al. Five-year results for endovascular repair of acute complicated type B aortic dissection. J Vasc Surg, 2014, 59(1): 96-106.
6. Zeeshan A, Woo EY, Bavaria JE, et al. Thoracic endovascular aortic repair for acute complicated type B aortic dissection: superiority relative to conventional open surgical and medical therapy. J Thorac Cardiovasc Surg, 2010, 140(6 Suppl): S109-115; discussion S142-S146.
7. 王雪钢, 白斗, 武少辉, 等. Stanford B型主动脉夹层胸主动脉腔内修复术术后内脏动脉血供改善情况分析. 中国胸心血管外科临床杂志, 2015, 22(2): 143-145.
8. Sachs T, Pomposelli F, Hagberg R, et al. Open and endovascular repair of type B aortic dissection in the Nationwide Inpatient Sample. J Vasc Surg, 2010, 52(4): 860-866.
9. Eggebrecht H, Nienaber CA, Neuhauser M, et al. Endovascular stent-graft placement in aortic dissection: a meta-analysis. Eur Heart J, 2006, 27(4): 489-498.
10. Steuer J, Eriksson MO, Nyman R, et al. Early and long-term outcome after thoracic endovascular aortic repair (TEVAR) for acute complicated type B aortic dissection. Eur J Vasc Endovasc Surg, 2011, 41(3): 318-323.
11. Garbade J, Jenniches M, Borger MA, et al. Outcome of patients suffering from acute type B aortic dissection: a retrospective single-centre analysis of 135 consecutive patients. Eur J Cardiothorac Surg, 2010, 38(3): 285-292.
12. Shah AA, Barfield ME, Andersen ND, et al. Results of thoracic endovascular aortic repair 6 years after United States Food and Drug Administration approval. Ann Thorac Surg, 2012, 94(5): 1394-1399.
13. Kato N, Hirano T, Kawaguchi T, et al. Aneurysmal degeneration of the aorta after stent-graft repair of acute aortic dissection. J Vasc Surg, 2001, 34(3): 513-518.
14. Nauta FJ, Conti M, Kamman AV, et al. Biomechanical changes after thoracic endovascular aortic repair in type b dissection: a systematic review. J Endovasc Ther, 2015, 22(6): 918-933.
15. Sueyoshi E, Sakamoto I, Hayashi K, et al. Growth rate of aortic diameter in patients with type B aortic dissection during the chronic phase. Circulation, 2004, 110(11 Suppl 1): II256-261.
16. Parodi JC, Berguer R, Ferreira LM, et al. Intra-aneurysmal pressure after incomplete endovascular exclusion. J Vasc Surg, 2001, 34(5): 909-914.
17. Chung JW, Elkins C, Sakai T, et al. True-lumen collapse in aortic dissection: part I. Evaluation of causative factors in phantoms with pulsatile flow. Radiology, 2000, 214(1): 87-98.
18. Kusagawa H, Shimono T, Ishida M, et al. Changes in false lumen after transluminal stent-graft placement in aortic dissections: six years' experience. Circulation, 2005, 111(22): 2951-2957.
19. Tsukube T, Hayashi T, Kawahira T, et al. Neurological outcomes after immediate aortic repair for acute type A aortic dissection complicated by coma. Circulation, 2011, 124(11 Suppl): S163-167.
20. Virtue Registry Investigators. The VIRTUE Registry of type B thoracic dissections--study design and early results. Eur J Vasc Endovasc Surg, 2011, 41(2): 159-166.
21. Virtue Registry Investigators. Mid-term outcomes and aortic remodelling after thoracic endovascular repair for acute, subacute, and chronic aortic dissection: the VIRTUE Registry. Eur J Vasc Endovasc Surg, 2014, 48(4): 363-371.
22. Takeuchi T, Adachi H, Ohuchida M, et al. A case-control study found that low albumin and smoking were associated with aortic dissection. J Clin Epidemiol, 2004, 57(4): 386-391.
23. Kakafika AI, Mikhailidis DP. Smoking and aortic diseases. Circ J, 2007, 71(8): 1173-1180.
24. He X, Liu X, Liu W, et al. Association between diabetes and risk of aortic dissection: a case-control study in a Chinese population. PLoS One, 2015, 10(11): e0142697.
25. Nienaber CA. Diabetes mellitus and thoracic aortic disease: are people with diabetes mellitus protected from acute aortic dissection? J Am Heart Assoc, 2012, 1(3): e001404.
26. Dua MM, Miyama N, Azuma J, et al. Hyperglycemia modulates plasminogen activator inhibitor-1 expression and aortic diameter in experimental aortic aneurysm disease. Surgery, 2010, 148(2): 429-435.
27. Astrand H, Ryden-Ahlgren A, Sundkvist G, et al. Reduced aortic wall stress in diabetes mellitus. Eur J Vasc Endovasc Surg, 2007, 33(5): 592-598.
28. Feng J, Lu Q, Zhao Z, et al. Restrictive bare stent for prevention of stent graft-induced distal redissection after thoracic endovascular aortic repair for type B aortic dissection. J Vasc Surg, 2013, 57(2 Suppl): 44S-52S.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Causes and Risk Factors of Multiple-interventions in Endovascular Repair for Aortic Dissection

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