title: Reintervention after thoracic endovascular aortic repair of complicated aortic dissection.
abstract: OBJECTIVE
  This study assessed predictive factors for reintervention after thoracic endovascular aortic repair (TEVAR) for complicated aortic dissection (C-AD).
  
  
  METHODS
  An institutional review of consecutive TEVAR for C-AD was performed.
  
  
  RESULTS
  Between 2000 and 2011, 41 patients underwent TEVAR for a C-AD involving the descending thoracic aorta. Primary indications included aneurysm >55 mm in 24, rapid aneurysmal enlargement or impending rupture in 6, saccular aneurysm >20 mm in 1, malperfusion in 1, intractable chest pain in 3, and rupture in 6. Technical success was achieved in 100%. The 30-day mortality rate was 5% (n = 2). Fourteen secondary procedures were performed in 13 patients (32%) for indications of device migration in 2, proximal type I endoleak in 5, distal type I endoleak in 2, type II endoleak in 1, aneurysmal evolution of the descending thoracic aorta in 2, aneurysmal expansion of the dissected abdominal aorta in 1, and retrograde dissection in 1. Multivariate analysis demonstrated that oversizing ≥20% (odds ratio [OR], 16; P = .011), bare-spring stent in the proximal landing zone of the stent graft (OR, 12; P = .032), and anticoagulant therapy (OR, 78; P = .03) were significant factors for reintervention. On univariate analysis, large aneurysm was a risk factor for reintervention (P = .002), whereas complete false lumen thrombosis at the stent graft level was protective (P < .05).
  
  
  CONCLUSIONS
  This study confirms the feasibility of TEVAR for C-AD, although the rate of reintervention is high. Excessive oversizing, a bare-spring stent graft in the proximal landing zone, large aortic dilatation, and anticoagulant therapy were factors associated with reintervention. Complete false lumen thrombosis at the stent graft level was protective.
authors.affiliation: Department of Thoracic and Vascular Surgery, University Hospital, Montpellier, France; U1046, Institut National de la Santé et de la Recherche Médicale, Université Montpellier 1, Montpellier, France. Electronic address: elsafaure@hotmail.com.
authors.forename: Elsa M
authors.initials: EM
authors.lastname: Faure
authors.affiliation: Department of Thoracic and Vascular Surgery, University Hospital, Montpellier, France; U1046, Institut National de la Santé et de la Recherche Médicale, Université Montpellier 1, Montpellier, France.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Canaud
authors.affiliation: Clinical Research and Epidemiology Department, University Hospital, Montpellier, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Agostini
authors.affiliation: Clinical Research and Epidemiology Department, University Hospital, Montpellier, France.
authors.forename: Roxane
authors.initials: R
authors.lastname: Shaub
authors.affiliation: Department of Thoracic and Vascular Surgery, University Hospital, Montpellier, France.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Böge
authors.affiliation: Department of Thoracic and Vascular Surgery, University Hospital, Montpellier, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Marty-ané
authors.affiliation: Department of Thoracic and Vascular Surgery, University Hospital, Montpellier, France; U1046, Institut National de la Santé et de la Recherche Médicale, Université Montpellier 1, Montpellier, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Alric
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000925:Anticoagulants / Q000009:adverse effects; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D057867:Endoleak / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011474:Prosthesis Design; D012086:Reoperation; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants