Restrictive bare stent for prevention of stent graft-induced distal redissection after thoracic endovascular aortic repair for type B aortic dissection

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Restrictive bare stent for prevention of stent graft-induced distal redissection after thoracic endovascular aortic repair for type B aortic dissection

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Restrictive bare stent for prevention of stent graft-induced distal redissection after thoracic endovascular aortic repair for type B aortic dissection Jiaxuan Feng, MD, Qingsheng Lu, MD, Zhiqing Zhao, MD, Junmin Bao, MD, Xiang Feng, MD, Lefeng Qu, MD, Jian Zhou, PhD, Zaiping Jing, MD Journal of Vascular Surgery Volume 57, Issue 2, Pages 44S-52S (February 2013) DOI: 10.1016/j.jvs.2012.06.117 Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 1 A, Measurement of the aorta, true lumen, and false lumen on four planes: P1, at the level of the descending aorta with maximum diameter; P2, at the level of the descending aorta with narrowest true lumen; P3, at the level of the distal end of the stent graft; P4, at the distal re-entry; a, the designed distal diameter of the stent graft. B, Measurement and definition of mismatch rate (MR). The cartoon is the cross-sectional view of the descending aorta at the level of the distal end of the stent graft. TL, true lumen; FL, false lumen; SD, short diameter; LD, long diameter. The LD of the true lumen was taken as the b value. The SD was measured to evaluate morphological remodeling of the dissected aorta, whereas the LD was measured to choose the size of the restrictive bare stent and calculate the mismatch rate. C, We took the short tracks as the diameters of the true lumen and false lumen in evaluating aortic remodeling. T, True lumen; F, false lumen. Journal of Vascular Surgery 2013 57, 44S-52SDOI: (10.1016/j.jvs.2012.06.117) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 2 A, Preoperative aortography showed that the true lumen was extremely narrow at the middle part of descending aorta. B, The restrictive bare stent (RBS) was placed at the intended distal part of the stent graft, making the length of overlap with the stent graft 30 to 40 mm. C, Then the stent graft was deployed to exclude the proximal entry tear, and the distal part of the stent-graft was restricted by the RBS. D, One-year follow-up computed tomography angiogram showing that the false lumen was completely excluded and the true lumen expanded well. No endoleak, dislodging, or local erosion was evident. Journal of Vascular Surgery 2013 57, 44S-52SDOI: (10.1016/j.jvs.2012.06.117) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 3 A, Preoperative computed tomography angiography (CTA) revealed a complicated type B dissection in patient 6. The true lumen was severely compressed by the false lumen. B, Moderate type I endoleak detected 3 months after primary thoracic endovascular aortic repair (TEVAR). C, D, The distal end of the stent graft perforated the flap. The stent graft-induced distal redissection and aneurysmal expansion of the false lumen were revealed by CTA at 18 months. E, The true lumen of the distal descending aorta was so narrow that the abdominal organs were in a state of ischemia. The blood supply to both lower limbs was from the false lumen. F, After the secondary TEVAR + RBS through the right carotid artery, the redissection was completely excluded, and the true lumen of the distal descending aorta was obviously expanded, which remarkably improved the blood supply to abdominal organs. CTA at 10 months after the secondary intervention confirmed the patency of the bypass and the original type I endoleak, which will be treated by further intervention. Journal of Vascular Surgery 2013 57, 44S-52SDOI: (10.1016/j.jvs.2012.06.117) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 4 Kaplan-Meier estimates of 48-month cumulative proportion surviving in the thoracic endovascular aortic repair (TEVAR) group and TEVAR + restrictive bare stent (RBS) group. SIDR, Stent graft-induced distal redissection. Journal of Vascular Surgery 2013 57, 44S-52SDOI: (10.1016/j.jvs.2012.06.117) Copyright © 2013 Society for Vascular Surgery Terms and Conditions