Yujiro Ito
Current Position
Chief of Aortic center
Chibanishi General Hospital, Department of Cardiovascular Surgery
Thoracic Aorta (II) Session

Topic: TEVAR for type B dissection - Thinking of minimally invasive TEVAR for preemptive treatment


Preemptive thoracic endovascular aortic repair (TEVAR) is known as an advanced treatment that has potential to prevent aortic dilatation and improve late outcomes in patients with subacute type B aortic dissection (TBAD). As for this preventive aspect, less invasive, and uncomplicated TEVAR is preferable. For proximal landing in TEVAR, a 2-cm segment of healthy aorta is recommended. In TBAD, however, the proximity of the primary entry tear to the origin of the left subclavian artery or retrograde extension of the false lumen can make this difficult to achieve without coverage of aortic arch branches. Although, the majority of preemptive TEVARs are performed with a healthy proximal landing less than 2cm, and a majority without type 1a endoleaks, there are unfortunate complications including retrograde type A dissection that can occur. As the aortic arch draws a 3 dimension curve, there is an angle change from the aortic arch to descending aorta, and we call this “inflection point”. To achieve a valid proximal landing, we consider at least 1 stent should cross over the inflection point and deployed parallel to the aortic arch. In other words, entry closure in TBAD is not required for 2cm of healthy proximal landing if this deployment is successful. We discuss our experience and analysis.