I-Hui Wu
Nationality
Taiwan
Current Position
Vascular Surgeon/Clinical Professor
Organization
National Taiwan University Hospital
Thoracic Aorta Session

Topic: Risk Stratification of Best Medical Therapy in Acute Uncomplicated Type B Intramural Hematoma

Abstract

Background: Best medical therapy (BMT) for acute uncomplicated type B intramural hematoma (TBIMH) is associated with significant failure rate. This study aimed to identify potential risk factors for BMT failure and develop a risk score to aid clinical decision making.

Methods: Patients with acute uncomplicated TBIMH between 2011 January to 2020 December were retrospectively reviewed. Logistic regression was applied to assess potential risk predictors univariately, and the results of multivariable models was then utilized to formulate a simplified prediction model for BMT failure.

Results: In a total of 61 patients, the overall rate of BMT failure was 57.4% (35/61), of which 48.6% (17/35) occurred within 28 days of onset. On logistic regression, maximal descending aortic diameter (HR=1.99 CI=1.16-3.40, p=0.012), initial IMH thickness (HR=3.29, CI=1.28-8.46, p=0.013) and the presence of focal contrast enhancement (HR=3.12, CI=1.49-6.54, p=0.003) were identified as potential risk predictors for BMT failure. A risk score was calculated as followed: [Max DTA diameter (mm)*0.6876 + Max IMH thickness (mm)*1.1918 + PAU/ULP *1.1369]. The freedom from BMT failure at 1 year was 72% for patients with a risk score <4.12, in contrast to only 35.1% for those with a risk scoreā‰§4.12.

Conclusions: A significant proportion of patients with acute uncomplicated TBIMH failed initial BMT. Based on the three initial computed tomographic imaging variables, this risk score could help to stratify patients who were at high or low risk of BMT failure and provided additional information for early intervention.

Thoracic Aorta Session

Topic: Intimal tear-oriented treatment in aortic dissection

Abstract

Background:

Thoracic endovascular aortic repair (TEVAR) can only promote 55-80% false lumen (FL) thrombosis when only the proximal primary tear is covered during the repair of type B aortic dissection (TBAD). This study evaluated the effectiveness and clinical outcome of tailored exclusion of the primary entry tear with TEVAR and distal fenestrations with ancillary devices in patients with subacute or chronic Crawford type III and IV aortic dissection aneurysm.

Methods:

All patients underwent either TEVAR for primary entry tear; subsequently, various ancillary devices were applied on each distal fenestration. These techniques included covered stent occlusion of detached visceral artery entry tears, TL stenting and FL occlusion with vascular plugs in the common iliac artery dissection, or TEVAR coverage for multiple fenestrations from segmental arteries. This case series included nine patients (seven men and two women; mean age: 63.4 years) during January 2013 to May 2019. Outcome analysis included the rates of technical success and procedure-related complications, completeness of FL occlusion, aortic remodeling, and midterm mortality at 2 years.

Results:

The mean follow-up duration was 37.7 months without in-hospital mortality. One patient was lost to follow-up at the second month, the rest of patients were all alive during the follow-up period. All patients achieved complete FL thrombosis, and six patients exhibited aneurysm diameter shrinkage.

Conclusion:

Tailored exclusion of visceral and iliac distal fenestrations with proximal primary tear coverage can promote FL thrombosis and aortic remodeling in the visceral aortic segment in patients with Crawford type III or IV aortic dissection aneurysm.