Endovascular treatment of patients concurrent with type 3A aortic syndrome and degeneration (infrarenal) abdominal aortic aneurysm.

BACKGROUND

Advances in endovascular treatments have improved surgical outcomes for patients with aortic pathologies. However, for patients with comorbid aortic dissection and degenerative abdominal aortic aneurysm (AAA), effective surgical treatment is often a challenge. Here, we analyzed the outcomes of endovascular treatment in patients who concurrently had acute DeBakey type 3A aortic syndrome and degenerative infrarenal AAA.

METHODS

From 2012 to 2019, 11 patients were diagnosed concurrently with acute type 3A aortic syndrome and degenerative infrarenal AAA that met intervention criteria (typical acute descending aortic dissection, or thickness of hematoma or ulceration greater than 10 mm in intramural hematomas [IMH] or penetrating aortic ulcers [PAU], in addition to AAA diameter >5 cm). Three patients had a typical dissection, three had IMH, and five had PAU.

RESULTS

Four men underwent a one-stage operation, and preoperative cerebrospinal fluid lumbar drainage was instituted in three patients. The other seven patients underwent a two-stage operation consisting of endovascular aneurysm repair (EVAR) followed by thoracic endovascular aortic repair (TEVAR) over a period ranging from 3 to 52 months. Follow-up continued until the end of 2022. No spinal cord ischemia (SCI) was present in either group. In the one-stage group, one patient died of intracranial hemorrhage 1.5 months after the operation. The other three patients did not experience any aortic event requiring reintervention. In the two-stage group, four patients required reintervention, including one type I endoleak, 2 type II endoleaks, and one visceral artery stent compromise. In this group, four patients died during follow-up.

CONCLUSION

Mid-term outcomes were acceptable in patients with concurrent acute type 3A aortic syndrome and degenerative infra-renal AAA, managed with EVAR and TEVAR, both simultaneously and sequentially. The incidence of SCI was low, and aortic coverage spared the segment from T8 to L1.