Abstract 19090: Identification and Classification of Descending Aorta Re-entry Sites in Type I Aortic Dissection
Introduction: False lumen patency along the downstream aorta after proximal aortic surgery for acute type I aortic dissection (AD) is associated with poor prognosis. We visualized and evaluated intraoperatively the position and morphology of distal re-entry sites in type I/III AD patients for treatment definition.
Methods: From 01.2008 - 05.2015 212 patients underwent surgery for AD via median sternotomy. In 124, acute (n=87) or chronic (n=37) type I/ III AD, a flexible videoscope, called angioscope, was used during the open arch repair for visualization of the descending aorta. The procedure was performed under isolated selective cerebral perfusion and hypothermic circulatory arrest distally. The position of the distal intimal lesions was defined according to the distance to left subclavian artery (LSA) origin. The lesions were classified as disrupted intercostal arteries, vertical- and oval- shaped lesions and circumferential obliteration of the intimal wall. The information was used for ad hoc extension of the aortic treatment.
Results: In 102/124 a total of 188 intimal lesions were identified, mean±SD 1.47±1.22/patient. In 22 no re-entry was found. Within 5cm, 6-10cm, 11-15cm and 16-20cm distal from the LSA reentries were found in 73%, 31%, 14% and 11% of the patients, respectively. Disrupted intercostal arteries were found in 42%, vertical in 36% and oval in 19%. A circumferential obliteration of the intimal wall was identified in 3% and only in chronic AD. Re-entries were excluded using the frozen elephant trunk (FET) technique in 94/124 obtaining a false lumen thrombosis in 94%. The angioscopy rescued the FET procedure from severe complication in 7 and guided antegradely a FET extension by a second graft in 2 patients.
Conclusions: The angioscopy of the downstream aorta enables the identification and classification of re-entries in patients underwent open arch surgery for AD. Visualization of the descending aorta pathology warrants the safety of endovascular treatment via the open arch.
Author Disclosures: K. Tsagakis: None. D.S. Dohle: None. R.A. Jánosi: None. T. Schlosser: None. J. Benedik: None. D. Wendt: None. M. Thielmann: None. R. Erbel: None. H. Jakob: None.
- © 2015 by American Heart Association, Inc.