Hybrid two-stage repair of Stanford A dissection with visceral or peripheral malperfusion
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(2020) 15:265
RESEARCH ARTICLE
Open Access
Hybrid two-stage repair of Stanford A dissection with visceral or peripheral malperfusion Zanxin Wang1,2, Xianmian Zhuang1, Bailang Chen1, Junmin Wen3 and Minxin Wei1,2*
Abstract Background: The present study aimed to evaluate the effect of two-stage hybrid aortic repair at the distal aorta of Stanford A dissection with malperfusion. Methods: This retrospective case series included 20 patients with Stanford A dissection administered two-stage thoracic endovascular aortic repair (TEVAR) about 1 month after central repair because of visceral or limb malperfusion. The patients were examined by computed tomography (CT) angiography at 3, 6, 12 and 24 months after operation. Recovery of malperfusion and true lumen index were evaluated during follow-up. Results: Twenty patients underwent two-stage hybrid aortic repair, including 11 males and 9 females. The followup time was 24 ± 7 months. No intervention-related complications were observed, including stent graft-induced new re-entry tears, death, stroke and spinal cord injury. Malperfusion in all cases was corrected. The true lumen was not enlarged enough 1 month after the first surgery. Thrombosis of the false lumen was observed around the elephant trunk at the carina level and the celiac artery. Three months after second stage TEVAR, the false lumen thrombosis was resorbed; in addition, the trunk was fully expanded at the carina level, and the true lumen was enlarged at the celiac artery. Conclusions: Two-stage hybrid aortic repair for residual true lumen in the distal aorta 1 month after initial surgery is helpful for descending aorta remodeling and effective in treating malperfusion. This procedure may be a good option for patients suffering from Stanford A dissection with small true lumen in the distal aorta and malperfusion. Keywords: Aortic dissection, Malperfusion, Hybrid procedure, Thoracic endovascular aortic repair
Background Stanford A aortic dissection is an acute condition characterized by the disruption of the thoracic aortic media layer caused by intramural bleeding separating the aortic wall layers; it leads to the formation of true and false lumen with or without communication [1–4]. Open surgery (total arch * Correspondence: [email protected] 1 Department of Cardiac Surgery, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Guangdong, People’s Republic of China 2 Department of Cardiac Surgery, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Guangdong, People’s Republic of China Full list of author information is available at the end of the article
replacement combined with elephant trunk stent implantation) is routinely applied in most cardiac centers. However, it is only the first step aiming to avoid lethal complications [5]. Small true lumen in distal descending aorta leading to malperfusion is a potential risk factor for poor long-term prognosis [6]. The malperfusion syndrome can affect different vascular beds depending upon the exact location of the aortic tear: spinal cord, vi
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