Thoracic Endovascular Aortic Repair (TEVAR) first in patients with lower limb ischemia in complicated type B aortic dissection

• Verfasst von: Meisenbacher, Katrin [VerfasserIn]
• Verfasst von: Hagedorn, Matthias [VerfasserIn]
• Verfasst von: Skrypnik, Denis [VerfasserIn]
• Verfasst von: Kilian, Samuel [VerfasserIn]
• Verfasst von: Böckler, Dittmar [VerfasserIn]
• Verfasst von: Bischoff, Moritz [VerfasserIn]
• Verfasst von: Peters, Andreas [VerfasserIn]
• Titel: Thoracic Endovascular Aortic Repair (TEVAR) first in patients with lower limb ischemia in complicated type B aortic dissection
• Titelzusatz: clinical outcome and morphology
• Verf.angabe: Katrin Meisenbacher, Matthias Hagedorn, Denis Skrypnik, Samuel Kilian, Dittmar Böckler, Moritz S. Bischoff and Andreas S. Peters
• E-Jahr: 2022
• Jahr: 17 July 2022
• Umfang: 14 S.
• Fussnoten: Gesehen am 17.08.2022
• Titel Quelle: Enthalten in: Journal of Clinical Medicine
• Ort Quelle: Basel : MDPI, 2012
• Jahr Quelle: 2022
• Band/Heft Quelle: 11(2022), 14, Artikel-ID 4154, Seite 1-14
• ISSN Quelle: 2077-0383
• DOI: doi:10.3390/jcm11144154
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: aortic dissection
• Sach-SW: complicated type B dissection
• Sach-SW: extremity malperfusion
• Sach-SW: lower limb ischemia
• Sach-SW: malperfusion
• Sach-SW: TEVAR
• Sach-SW: thoracic endovascular repair
• K10plus-PPN: 1814538291
• K10plus-PPN:
  Universitätsbibliothek
• Lokale URL UB: Zum Volltext

Abstract

Acute Type B aortic dissection (TBAD) can cause organ malperfusion, e.g., lower limb ischemia (LLI). Thoracic endovascular aortic repair (TEVAR) represents the standard treatment for complicated TBAD; however, with respect to LLI, data is scant. The aim of this study was to investigate clinical and morphological outcomes in patients with complicated TBAD and LLI managed with a “TEVAR-first” policy. Between March 1997 and December 2021, 731 TEVAR-procedures were performed, including 106 TBAD-cases. Cases with TBAD + LLI were included in this retrospective analysis. Study endpoints were morphological/clinical success of TEVAR, regarding aortic and extremity-related outcome, including extremity-related adjunct procedures (erAP) during a median FU of 28.68 months. A total of 20/106 TBAD-cases (18.8%, 32-82 years, 7 women) presented with acute LLI (12/20 Rutherford class IIb/III). In 15/20 cases, true lumen-collapse (TLC) was present below the aortic bifurcation. In 16/20 cases, TEVAR alone resolved LLI. In the remaining four cases, erAP was necessary. A morphological analysis showed a relation between lower starting point and lesser extent of TLC and TEVAR success. No extremity-related reinterventions and only one major amputation was needed. The data strongly suggest that aTEVAR-first-strategy for treating TBAD with LLI is reasonable. Morphological parameters might be of importance to anticipate the failure of TEVAR alone.