Endovascular treatment of isolated abdominal aortic dissection and postoperative aortic remodeling

Abstract

Objective: We report our experience of endovascular management and postoperative aortic remodeling of all types of isolated abdominal aortic dissection (IAAD).

Methods: This was retrospective study of 28 IAAD patients treated by endovascular means in our department between January 2007 and July 2013. We reviewed the risk factors, clinical features, computed tomography images, follow-up results, and aortic remodeling of these IAAD patients and propose a new morphologic classification into three types-supraceliac, paravisceral, and infrarenal-according to the location of the primary entry site.

Results: There were four supraceliac IAADs, one paravisceral IAAD, and 23 infrarenal IAADs in our case series. Suprarenal (supraceliac + paravisceral) IAAD patients were relatively younger than infrarenal patients (45.2 ± 8.6 years vs 60.6 ± 15.5 years; P < .05). No difference was observed between suprarenal and infrarenal IAADs with respect to true lumen, false lumen, and dissection length on imaging (P > .05). All patients received endovascular treatment. The primary technical success rate was 100%. During a follow-up of 35.7 ± 19.9 months, only one infrarenal patient needed an endovascular reintervention. All patients with supraceliac or infrarenal IAADs were alive at the time of follow-up; however, a paravisceral patient died of a dissecting abdominal aortic aneurysm rupture 21 months after endovascular treatment. In the suprarenal and infrarenal groups, endovascular treatment was associated with a significant decrease in the false lumen size and increase in the true lumen size (P < .05). The maximum abdominal aorta diameter decreased after endovascular treatment in both groups but was statistically significant only in the infrarenal group (P < .05).

Conclusions: IAAD is a rare vascular disease. We propose it should be categorized as supraceliac, paravisceral, and infrarenal IAAD according to the location of the primary entry site. Endovascular treatment for supraceliac and infrarenal IAADs is a safe method with a high technical success rate and promising aortic remodeling, whereas endovascular treatment for paravisceral IAADs remains difficult.