Endovascular strategies for post-dissection aortic aneurysm (PDAA)
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(2020) 15:287
REVIEW
Open Access
Endovascular strategies for post-dissection aortic aneurysm (PDAA) Zhaoxiang Zeng†, Yuxi Zhao†, Mingwei Wu†, Xianhao Bao, Tao Li, Jiaxuan Feng*, Rui Feng* and Zaiping Jing*
Abstract Residual patent false lumen (FL) after type B aortic dissection (TBAD) repair is independently associated with poor long-term survival. Open surgery and endovascular repair result in good clinical outcomes in patients with AD. However, both treatments focus on proximal dissection but not distal dissection. About 13.4–62.5% of these patients present with different degrees of distal aneurysmal dilatation after primary repair. Although open surgery is the first-choice treatment for post-dissection aortic aneurysm (PDAA), there is a need for high technical demand since open surgery is associated with high mortality and morbidity. As a treatment strategy with minimal invasion, endovascular repair shows early benefits and low morbidity. For PDAA, the narrow true lumen (TL), rigid initial flap and branch arteries originating from FL have increased difficulties in operation. The aim of endovascular treatment is to promote FL thrombosis and aortic remodeling. Endovascular repair includes intervention from FL and TL sides. TL intervention techniques (parallel stent-graft, branched and fenestrated stent-graft among others) have been proven to be safe and effective in PDAA. Other FL intervention techniques that have been used in selected patients include FL embolization and candy-plug techniques. This article introduces available endovascular techniques and their outcomes for the treatment of PDAA. Keywords: TEVAR, Post-dissection aortic aneurysm, False lumen, Endovascular repair , Candy-plug
Introduction Thoracic endovascular aortic repair (TEVAR) is widely used for type B aortic dissection (TBAD) due to the availability of advanced endovascular techniques and acceptable outcomes. Currently, the treatment strategy of TEVAR is to enhance aortic remodeling as it excludes proximal tear, reduces blood pressure and induces thrombogenesis in the false lumen (FL) [1]. However, backflow from distal entry tears maintains perfusion to FL, inducing aneurysm formation. About 13.4–62.5% of patients show different degree of distal aneurysmal dilatation after TEVAR [2, 3]. The presence of distal residual tears affects the long-term survival of patients [4]. * Correspondence: [email protected]; [email protected]; [email protected] † Zhaoxiang Zeng, Yuxi Zhao and Mingwei Wu contributed equally to this work. Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai 200433, People’s Republic of China
Although open surgery is still the first-choice treatment for post-dissection aortic aneurysm (PDAA), it still requires high technical demands and is also associated with increased mortality and morbidity [5]. Endovascular strategies regarded as less invasive treatment with good early outcomes are suitable for patients unable to tolerate open surgery. The indications for endovascular
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