TAA 20. Analysis for Deteriorating Development of Aortic Dissection After Thoracic Endovascular Aortic Repair

As the preferred method for treatment of type B dissection, thoracic endovascular aortic repair (TEVAR) has been recognized by clinicians for its efficacy compared with open surgery. However, some serious complications still occur after TEVAR, such as progression of anterograde tear of the dissection, formation of new intimal rupture, rupture of the dissection aneurysm, and retrograde type A dissection (RTAD). Although the incidence rate of these complications is not high, the consequence is serious and should cause the clinician's attention. A retrospective analysis was performed of 53 patients with type B aortic dissection treated with TEVAR from January 2009 to December 2018. Complications occurred in six cases after TEVAR, with an incidence of 11.3%. RTAD occurred in two cases, and one patient died 2 hours after TEVAR. Another one was found by computed tomography angiography re-examination 2 weeks after TEVAR, and this patient's condition was stable after conservative treatment, such as blood pressure control. Two patients suffered from ruptured dissecting aneurysm of the descending arch, and one died within 1 hour after TEVAR; this patient was diagnosed with Marfan syndrome preoperatively. In the other patient, ruptured dissecting aneurysm occurred 5 hours after TEVAR; the patient survived with first-aid measures, including 1200-mL blood transfusion, and finally recovered by thoracic closed drainage and thoracoscopic hematoma removal. Two patients presented with progressive anterograde intimal tearing, and their condition was stable after conservative treatment. Some factors of postoperative complications of TEVAR are related to the patient's condition, such as Marfan syndrome. Uncontrolled severe hypertension was significantly associated with continued progress of the dissection or rupture of the dissected aneurysm. The occurrence of RTAD is related to the anchorage area near the proximal portion of the stent. The progression of anterograde intimal tear is related to the lesion of the endarterium at the distal end of the stent, such as significant narrowing of the true lumen. Materials and design of the stent also have an impact on the occurrence of complications after TEVAR. In addition, it is important to avoid iatrogenic injury during the endovascular procedure.