Aortic Symposium

New York 2012

„Pseudoaneurysm After Endovascular Stent Graft

Placement for Treatment of Type B Aortic Dissection“

R.A. Jánosi, M. Bettin, T. Konorza, H. Kälsch, H. Eggebrecht, R. Erbel

Department of CardiologyWest German Heart Center Essen

Patient Characteristics

no DPA DPA p

patients 143 (95 %) 8 (5 %)

male 96 (63 %) 5 (63 %) 0,786

age (y) 62,2 ± 12,8 (22-84) 60,7 ± 8,7 (48-71) 0,746

Time to Treatment (mo) 4,3 ± 11,9 20,3 ± 36,3 0,251

acute dissection 62 1 0,64

stent graft diameter (mm) 34,0 ± 5,1 33,0 ± 1,5 0,589

stent graft length (mm) 153,2 ± 43,1 158,1 ± 40,0 0,753

Angle (°) 167,1 ± 12,4 148,2 ± 16,5 <0,05

reintervention 18 (13 %) 7 (88 %)* <0,05

Time to reintervention (mo) 27,8 ± 24,6 19,1 ± 15,1 0,364

Characteristics of 8 patients complicated with DPA afterEndografting for Type B Dissection

patient

Age Initial Indication Coexisting conditions

Onset timeIntervention>diagnosis DPA (mo)

Stent graft extension

Duration of follow up (mo)

DPA (mm)

Stent

1 70 Recurrent pain, impending rupture

HTN 16 yes 45 15x35 Valiant

2 59 Recurrent pain HTN 3 yes 27 22x34 Relay

3 47 Recurrent pain, Malperfusion

HTN 19 yes 27 10x16 Valiant

4 68 Recurrent pain HTN 50 yes 80 39x44 Talent

5 67 Recurrent pain HTN, MI

76 yes 109 20x34 Talent

6 65 Recurrent pain HTN, CHD

14 yes 13 13x25 Relay

7 58 Recurrent pain HTN 115 refused 115 - Talent

8 49 Progredient FL-aneurysm

HTN 26 yes 26 9x28 Valiant

10,08,06,04,02,00,0

Zeit TEVAR bis Reintervention

1,0

0,8

0,6

0,4

0,2

0,0

Ver

lau

f o

hn

e R

ein

terv

enti

on

nein-censored

ja-censored

nein

ja

DistalesPseudoaneurysma

Rat

e of

free

dom

Rei

nter

vent

ion

years

DistalPseudoaneurysm

YesNoYes-censoredNo-censored

When passively bent at the arch, the self-expanding stent graft has theinherent tendency to spring back toits initial straight status.

When passively bent at the arch, the self-expanding stent graft has theinherent tendency to spring back toits initial straight status.

Conclusions

•Endovascular treatment in chronic type B dissection has a

high technical success rate and low mortality•Pseudoaneurysm of the thoracic aorta is a rare and

potentially fatal condition•Potential mechanism:

• Trauma caused by the semi-rigid stent graft• Fragility of the aortic wall and disease progression• Excessive radial force due to distal oversizing of the

stent graft prosthesis to > 20%Development of dissection-specific, less-rigid endo-

prosthesis

Characteristics of 8 patients complicated with DPA afterEndografting for Type B Dissection

patient

Age Initial Indication Coexisting conditions

Oversizing

Onset timeIntervention>diagnosis DPA (mo)

Stent graft extension

Duration of follow up (mo)

DPA (mm)

Stent

1 70 Recurrent pain, impending rupture

HTN 16 yes 45 15x35 Valiant

2 59 Recurrent pain HTN 3 yes 27 22x34 Relay

3 47 Recurrent pain, Malperfusion

HTN 19 yes 27 10x16 Valiant

4 68 Recurrent pain HTN 50 yes 80 39x44 Talent

5 67 Recurrent pain HTN, MI

76 yes 109 20x34 Talent

6 65 Recurrent pain HTN, CHD

14 yes 13 13x25 Relay

7 58 Recurrent pain HTN 115 refused 115 - Talent

8 49 Progredient FL-aneurysm

HTN 26 yes 26 9x28 Valiant