Tae K. Song, MD, Carlos E. Donayre, MD, Irwin Walot, MD, George E

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Presentation transcript:

Endograft exclusion of acute and chronic descending thoracic aortic dissections Tae K. Song, MD, Carlos E. Donayre, MD, Irwin Walot, MD, George E. Kopchok, BS, Roman A. Litwinski, MD, Maurice Lippmann, MD, Grant E. Sarkisyan, MD, Bassam Omari, MD, Rodney A. White, MD Journal of Vascular Surgery Volume 43, Issue 2, Pages 247-258 (February 2006) DOI: 10.1016/j.jvs.2005.10.065 Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 1 Intravascular ultrasound (IVUS) images of aortic dissection pre-endograft (left) and post-endograft deployment (right) demonstrate the dimensions of the true lumen (arrows) at the same aortic level. Real-time predeployment images show pulsatile flow in the false lumen with severe compromised flow in the true lumen. The postprocedure IVUS image demonstrates enlargement of the true lumen with pulsatile flow in the true lumen and stagnation of flow in the false lumen (f) after coverage of the proximal entry site. Journal of Vascular Surgery 2006 43, 247-258DOI: (10.1016/j.jvs.2005.10.065) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 2 Preoperative (left) and postdeployment (right) images demonstrate the method of calculating total volume in the thoracic aorta from the top of the aortic arch to the celiac axis. The ascending aorta and arch contributing to the total volume were assumed to be constant between sequential imaging. At the level of aorta denoted by an asterisk, the presence of true and false lumen is shown on the axial computed tomography (CT) image. The postdeployment axial CT image shows continued contrast within the false lumen (large arrow) (f) during the assessment for thrombosis of the false lumen. Journal of Vascular Surgery 2006 43, 247-258DOI: (10.1016/j.jvs.2005.10.065) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 3 Composite interactive three-dimensional computed tomography images of complete regression over 9 weeks of a 4.5-cm aneurysmal enlargement of an acute proximal descending aortic dissection with ongoing chest pain and extension of the dissection while on medical therapy following coverage of the proximal entry site with a single, 130-mm-long Talent thoracic endograft. Journal of Vascular Surgery 2006 43, 247-258DOI: (10.1016/j.jvs.2005.10.065) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 4 False lumen volume regression of acute and chronic dissections related to time. At the 6-month follow-up, there was a 66% decrease in false lumen (contrast) volume in the acute dissections (blue) and a 92% decrease in the chronic dissections (red) compared with preoperative values. Journal of Vascular Surgery 2006 43, 247-258DOI: (10.1016/j.jvs.2005.10.065) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 5 Impact of endoleak on percent change in true lumen volume related to time. A subanalysis of the acute dissections showed an increase in true lumen volume of 32% and 42% at 6 months and 12 months with no reintervention (blue) compared with a minimal increase in volume of 4.8% and 3.9% with reintervention (green). The chronic dissections (red) showed a similar increase in true lumen volume as acute dissections not requiring reintervention of 15.2% and 37.0% at 6 months and 12 months, respectively. Journal of Vascular Surgery 2006 43, 247-258DOI: (10.1016/j.jvs.2005.10.065) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 6 Impact of endoleak on total aortic volume related to time for acute and chronic dissections. At the 6- and 12-month follow-up intervals, there was 10.5% and 0% decrease in total aortic volumes for acute dissection not requiring reintervention (blue) compared with a decrease of 9.3% and 22.2% for chronic dissections (red). Acute dissections that required reintervention (green) demonstrated an increase in total aortic volume of 13.6% and 28.9% at 6 and 12 months, respectively. Journal of Vascular Surgery 2006 43, 247-258DOI: (10.1016/j.jvs.2005.10.065) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions