Single-branched stent-graft with on-table fenestration for endovascular repair of primary retrograde type A aortic dissection: A multicenter retrospective study

Heng Zhang; Jiaxuan Feng; Hongqiao Zhu; Shun Xiao; Mingyuan Liu; Yili Xu; Dongshan Yang; Junjun Liu; Mingjin Guo

doi:10.3389/fcvm.2022.1034654

Single-branched stent-graft with on-table fenestration for endovascular repair of primary retrograde type A aortic dissection: A multicenter retrospective study

Front Cardiovasc Med. 2022 Nov 17:9:1034654. doi: 10.3389/fcvm.2022.1034654. eCollection 2022.

Authors

Heng Zhang¹, Jiaxuan Feng², Hongqiao Zhu², Shun Xiao¹, Mingyuan Liu³, Yili Xu⁴, Dongshan Yang⁵, Junjun Liu¹, Mingjin Guo¹

Affiliations

¹ Department of Vascular Surgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, China.
² Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China.
³ Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
⁴ Department of Vascular Surgery, The 960th Hospital of the People's Liberation Army, Jinan, Shandong, China.
⁵ Department of Vascular Surgery, Cangzhou Central Hospital, Cangzhou, Hebei, China.

Abstract

Objective: This study aims to evaluate the feasibility, efficacy, and safety of a single-branched stent-graft with on-table fenestration for primary retrograde type A aortic dissection (RTAD) during thoracic endovascular aortic repair (TEVAR).

Materials and methods: From January 2019 to December 2021, 36 patients with primary RTAD from five tertiary hospitals received medical management in the acute phase. They underwent TEVAR with a proximal zone 1 landing for aortic arch reconstruction in the subacute phase, using a fenestration technique on a single-branched stent-graft. Nearly 2 weeks after admission, computed tomography angiography (CTA) was re-examined to evaluate the thrombosis status of retrograde false lumen (FL). The primary outcomes were technical success, patency of the target branch arteries, and absence of type Ia endoleaks. The second outcomes were stent-graft-related complications and all-cause mortality.

Results: The mean age was 56.2 ± 11.3 years, and 29 (80.6%) were male. After a median interval of 18.0 [interquartile range (IQR), 17.0-20.3] days of medical treatment, the partial and complete thrombosis of proximal FL rates increased to 52.8% and 47.2%, respectively. One patient (2.8%) experienced postoperative type Ia endoleaks, and was successfully re-treated using coli and Onyx glue. The median hospital stay was 20.5 (IQR, 18.0-23.0) days. The overall technical success rate was 100%. The median follow-up time was 31.5 (IQR, 29.8-34.0) months. There was one death (2.8%) due to gastrointestinal bleeding. Distal aortic segmental enlargement (DASE) occurred in two (5.6%) patients. No major complications or recurrent dissections in the proximal landing zone were recorded during follow up.

Conclusion: The retrograde FL in primary RTAD could realize partial or complete thrombosis after medical management in the acute phase, and it might be regarded as a valid proximal landing zone for endovascular repair. The single-branched stent graft with on-table fenestration performed in the subacute phase may be feasible strategy in selective primary RTAD patients.

Keywords: endoleaks; endovascular repair; primary retrograde type A aortic dissection; single-branched stent graft with on-table fenestration; thrombosis.