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Retrograde ascending aortic dissection during or after thoracic aortic stent graft placement: insight from the European registry on endovascular aortic repair complications.

Publication ,  Conference
Eggebrecht, H; Thompson, M; Rousseau, H; Czerny, M; Lönn, L; Mehta, RH; Erbel, R; European Registry on Endovascular Aortic Repair Complications,
Published in: Circulation
September 15, 2009

BACKGROUND: Single-center reports have identified retrograde ascending aortic dissection (rAAD) as a potentially lethal complication of thoracic endovascular aortic repair (TEVAR). METHODS AND RESULTS: Between 1995 and 2008, 28 centers participating in the European Registry on Endovascular Aortic Repair Complications reported a total of 63 rAAD cases (incidence, 1.33%; 95% CI, 0.75 to 2.40). Eighty-one percent of patients underwent TEVAR for acute (n=26, 54%) or chronic type B dissection (n=13, 27%). Stent grafts with proximal bare springs were used in majority of patients (83%). Only 7 (15%) patients had intraoperative rAAD, with the remaining occurring during the index hospitalization (n=10, 21%) and during follow-up (n=31, 64%). Presenting symptoms included acute chest pain (n=16, 33%), syncope (n=12, 25%), and sudden death (n=9, 19%) whereas one fourth of patients were asymptomatic (n=12, 25%). Most patients underwent emergency (n=25) or elective (n=5) surgical repair. Outcome was fatal in 20 of 48 patients (42%). Causes of rAAD included the stent graft itself (60%), manipulation of guide wires/sheaths (15%), and progression of underlying aortic disease (15%). CONCLUSIONS: The incidence of rAAD was low (1.33%) in the present analysis with high mortality (42%). Patients undergoing TEVAR for type B dissection appeared to be most prone for the occurrence of rAAD. This complication occurred not only during the index hospitalization but after discharge up to 1050 days after TEVAR. Importantly, the majority of rAAD cases were associated with the use of proximal bare spring stent grafts with direct evidence of stent graft-induced injury at surgery or necropsy in half of the patients.

Duke Scholars

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

September 15, 2009

Volume

120

Issue

11 Suppl

Start / End Page

S276 / S281

Location

United States

Related Subject Headings

  • Stents
  • Registries
  • Postoperative Complications
  • Middle Aged
  • Male
  • Intraoperative Complications
  • Humans
  • Female
  • Cardiovascular System & Hematology
  • Blood Vessel Prosthesis Implantation
 

Citation

APA
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ICMJE
MLA
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Eggebrecht, H., Thompson, M., Rousseau, H., Czerny, M., Lönn, L., Mehta, R. H., … European Registry on Endovascular Aortic Repair Complications, . (2009). Retrograde ascending aortic dissection during or after thoracic aortic stent graft placement: insight from the European registry on endovascular aortic repair complications. In Circulation (Vol. 120, pp. S276–S281). United States. https://doi.org/10.1161/CIRCULATIONAHA.108.835926
Eggebrecht, Holger, Matt Thompson, Hervé Rousseau, Martin Czerny, Lars Lönn, Rajendra H. Mehta, Raimund Erbel, and Raimund European Registry on Endovascular Aortic Repair Complications. “Retrograde ascending aortic dissection during or after thoracic aortic stent graft placement: insight from the European registry on endovascular aortic repair complications.” In Circulation, 120:S276–81, 2009. https://doi.org/10.1161/CIRCULATIONAHA.108.835926.
Eggebrecht, Holger, et al. “Retrograde ascending aortic dissection during or after thoracic aortic stent graft placement: insight from the European registry on endovascular aortic repair complications.Circulation, vol. 120, no. 11 Suppl, 2009, pp. S276–81. Pubmed, doi:10.1161/CIRCULATIONAHA.108.835926.
Eggebrecht H, Thompson M, Rousseau H, Czerny M, Lönn L, Mehta RH, Erbel R, European Registry on Endovascular Aortic Repair Complications. Retrograde ascending aortic dissection during or after thoracic aortic stent graft placement: insight from the European registry on endovascular aortic repair complications. Circulation. 2009. p. S276–S281.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

September 15, 2009

Volume

120

Issue

11 Suppl

Start / End Page

S276 / S281

Location

United States

Related Subject Headings

  • Stents
  • Registries
  • Postoperative Complications
  • Middle Aged
  • Male
  • Intraoperative Complications
  • Humans
  • Female
  • Cardiovascular System & Hematology
  • Blood Vessel Prosthesis Implantation