Inducing false lumen thrombosis for retrograde type A aortic dissection Rongjie Zhang, MD, Jian Zhou, MD, Jiaxuan Feng, MD, Zhiqing Zhao, MD, Junjun Liu,

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Presentation transcript:

Inducing false lumen thrombosis for retrograde type A aortic dissection Rongjie Zhang, MD, Jian Zhou, MD, Jiaxuan Feng, MD, Zhiqing Zhao, MD, Junjun Liu, MD, Zhenjiang Li, MD, Rui Feng, MD, Zaiping Jing, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 153, Issue 1, Pages 57-65 (January 2017) DOI: 10.1016/j.jtcvs.2016.09.022 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, Computed tomography aortography in the true lumen. B, Aortography in the false lumen. C, The first coil released, showing coil drift to the middle part of the thoracic aorta. D, The sixth coil released, with the coil zone extended to the aortic arch. E, The 13th coil released, with the coil zone extended to the ascending aorta. F, Onyx glue injection to enhance firmness. G, Aortography after the first operation, showing a satisfactory retrograde false lumen embolism. H, Aortography before the second operation, at 14 days after embolism. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 57-65DOI: (10.1016/j.jtcvs.2016.09.022) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Blood pressure at different levels of the aorta in the first-stage operation. TL, True lumen; FLB, false lumen before embolization; FLA, false lumen after embolization. *P < .05; **P < .001. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 57-65DOI: (10.1016/j.jtcvs.2016.09.022) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 A and B, Computed tomography angiography (CTA) reconstruction before the first-stage operation, showing the false lumen (short white arrows). C and D, CTA reconstruction after the first-stage operation, showing coils in the thrombus area (long white arrows). E and F, CTA reconstruction at 3 months after the second-stage operation, showing the stent graft (black arrows). The Journal of Thoracic and Cardiovascular Surgery 2017 153, 57-65DOI: (10.1016/j.jtcvs.2016.09.022) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Schematic diagram of the 2-stage strategy for managing retrograde type A aortic dissection (RTAD). A, The RTAD. B, Coil thrombosis of the retrograde false lumen. C, Retrograde false lumen thrombosed. D, Thrombosis area as a proximal landing zone for thoracic endovascular aortic repair. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 57-65DOI: (10.1016/j.jtcvs.2016.09.022) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Patient treated by TEVAR after retrograde false lumen inducing thrombosis of the retrograde false lumen. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 57-65DOI: (10.1016/j.jtcvs.2016.09.022) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Video 1 Computed tomography angiography showing 3D reconstructions (preoperative, after first-stage operation, and after the second-stage operation), and during the first- and second-stage operations showing the 2-stage approach to treating retrograde type A aortic dissection. Video available at: http://www.jtcvsonline.org/article/S0022-5223(16)31140-0/addons. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 57-65DOI: (10.1016/j.jtcvs.2016.09.022) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions