Long Term Outcomes of Endovascular Treatment for Retrograde Ascending Aortic Dissection.

OBJECTIVE

The optimal treatment for retrograde ascending aortic dissection (rAAD) remains unclear. In this study, the long term clinical outcomes of endovascular treatment for rAAD were investigated retrospectively, and haemodynamic remodelling of the ascending aorta was analysed.

METHODS

This retrospective, single centre study analysed clinical data of rAAD cases treated endovascularly from 2001 - 2020. Endpoints included aortic related death and re-intervention. Computational fluid dynamics (CFD) models were established to compare haemodynamic changes after endovascular repair.

RESULTS

A total of 85 patients with rAAD (mean age 52.8 ± 11.4 years, range 29.0 - 79.0 years) underwent thoracic endovascular aortic repair (TEVAR). Technical success was achieved in 73 patients (86%). In hospital death occurred in one patient (1%). During the 75 month median follow up (interquartile range 54, 101 months), all cause mortality was 7% (6/84, including two aortic related deaths). Overall survival rates for one, five, and ten years were 98.8%, 92.7%, and 88.6%, respectively. Sixteen aortic related adverse events were observed in 15 patients during follow up, including two proximal stent graft induced new entries (SINEs), two distal SINEs, and 12 primary endoleaks into the false lumen. Secondary endoleak was not observed. The free from aortic related event rates for one, five, and ten years were 77.3%, 74.3%, and 71.5%, respectively. Complete thrombosis or disappearance of the false lumen in the ascending aorta was observed in all cases. The true lumen diameter of the ascending aorta increased statistically significantly from 31.8 ± 5.2 mm (range 15.8 - 40.8 mm) to 35.4 ± 3.5 mm (range 28.3 - 44.0 mm) (p < .001) at the last follow up. CFD analysis showed that the median wall shear stress in the ascending aorta statistically significantly decreased from 16.4 Pa to 12.4 Pa (p = .006).

CONCLUSION

Encouraging short and long term outcomes were demonstrated using TEVAR for rAAD, suggesting that it may represent a treatment alternative to open repair in selected cases.