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Endovascular Treatment for Stanford B Aortic Dissection in Patients With Connective Tissue Disorders

2019; Elsevier BV; Volume: 58; Issue: 6 Linguagem: Inglês

10.1016/j.ejvs.2019.09.388

1532-2165

Jose Alonzo Leal Franco, José Francisco Ibáñez Rodríguez,

Connective tissue disorders research

Introduction: Through the last years, life expectancy in patients with connective tissue disorders has increased. Thoracic Endovascular Aortic Repair (TEVAR) has emerged as an alternative to open surgical repair for treatment for aortic complications such as aneurysms and aortic dissections. Open surgical treatment mortality rate is 33.9% compared to a rate of 9.3% with TEVAR. Today there is limited information about outcomes and complications of endovascular treatment for aortic disease in patients with conective tisue disorders. We present our experience on patients treated with TEVAR for Stanford B aortic dissection with Marfan Syndrome. Methods: Of 24 patients who underwent TEVAR between Janury 2016 and January 2018, 5 patients with 12 months follow up fullfilled de Ghent criteria for Marfan Syndrome and Stanford B aortic disection. Results: Mean age was 35.8 years, all of the patients presented acute symptoms 48 hours previous the intervention. 80% of the patients had high risk criteria for open surgical repair. One of the patients underwent a Bentall surgical procedure previous TEVAR. The mean maximum aortic diameter was 48.1 mm, aortic root mean diameter was 27.2 mm. 40% of the patients had CT imaging studies with positive criteria for rupture. The left subclavian artery was intentionally covered in 80% of the patients, the endograft mean diameter was 35.1 mm and the mean lenght was 161.2 cm. 40% presented endoleak type IA with immediate correction. 16% presented type IB endoleak with intraoperative correction, there were no cardiovascular events during the procedure, there was no in-hospital mortality, the survival at 12 months follow up was 100%. 60% of the patients presented type II endoleak, 16% of them with reintervention. 80% presented positive aortic remodeling. Conclusion: The management of aortic pathology in patients with connective tissue disorders is highly complex. Even though surgery is still the treatment of choice, nowadays endovascular treatment plays an important role as a low complication associated treatment for these patients, compared to open surgical outcomes. In our experience, it's a feasible and safe treatment for acute aortic dissection. In order to achieve the best outcomes, the right anatomic selection and the assesment of risk factors is crucial; nevertheless, it is imperative to perform long term multicentric studies to increase information to determinate the safety of endovascular treatment. Disclosure: Nothing to disclose