Application of occlusive devices in endovascular repair of Stanford type B aortic dissection with insufficient landing zones

Abstract

OBJECTIVES: Occlusion of intimal tear with occlusive devices is an alternative or adjuvant method for endovascular repair of Stanford type B aortic dissection (TBAD) with insufficient landing zones. This study aimed to evaluate the efficacy and safety of using occluders in highly selective TBAD patients inappropriate for conventional thoracic endovascular aortic repair (TEVAR). METHODS: All patients undergoing TEVAR between July 2009 and July 2015 were retrospectively reviewed and patients treated with only or adjuvant occlusive devices were included in the study. Demographic data, clinical characteristics, perioperative data, and follow-up were collected and analyzed. RESULTS: A total of 10 TBAD patients treated with occluders were included in the study. The mean age was 56.8 ± 12.7 years old and the majority of the patients were male (7/10). Only occluders were applied to seal the proximal tears in seven cases, while occluders combined with other endovascular techniques were used in three cases. No 30-day mortality operative reintervention was required in two cases. Eight patients were followed up for 10.0 ± 4.1 years and two cases were lost to follow-up. Three patients died during the follow-up period; one patient died of stroke, while the other two patients died due to noncardiovascular causes. One reintervention was performed due to endoleak 2 years after the surgery. CONCLUSIONS: The early and long-term outcomes of the 10 patients show that treating difficult aortic lesions unfit for traditional TEVAR with occluders is effective and safe. The technique may provide a treatment alternative in highly selective TBAD patients unfit for traditional TEVAR.