Potential risk factors of re-intervention after endovascular repair for type B aortic dissections.
OBJECTIVE
To assess the potential risk factors of re-intervention after thoracic endovascular aortic repair (TEVAR).


BACKGROUND
TEVAR has been chosen as a less invasive alternative for Type B aortic dissections (TBADs); however, the potential risk factors of re-intervention remain unclear.


METHODS
A total of 252 TBADs patients initially treated with TEVAR between September 1998 and July 2012 were retrospectively reviewed. The indications for the initial TEVAR were 32 aorta enlargement (24 chronic), 71 malperfusion, 46 rupture (32 chronic), 67 refractory pain (54 chronic), and 44 refractory hypertension (38 chronic). The patients were stratified into single-intervention group and multi-intervention group.


RESULTS
The mean age was 54.1 years with 81.7% of male. We found the time from symptom onset to TEVAR was longer in multi-intervention group (17 vs. 112.5 days, P = 0.006). Higher proportions of chronic dissection and smoking occurred in multi-intervention group (53.9% vs. 79.2% and 43.9% vs. 70.8%, P = 0.018 and 0.012, respectively). The differences of oversizing, operation time, contrast medium dose, and blood loss between the groups were significant (13.8 ± 2.4% vs. 16.4 ± 2.9%, 92.5 vs. 196 minutes, 110 vs. 210 ml, 100 vs. 300 ml; P < 0.001, <0.001, =0.002, and =0.003, respectively). The mortality within 30 days was 2.4% and the rates of stoke, paraplegia and retrograde dissection were 3.6%, 5.6% and 0.8%, respectively. The most common reasons of re-intervention were endoleaks, new dissections and incomplete thrombosis of the false lumen.


CONCLUSIONS
we concluded that chronic phase, smoking and too big oversizing were potential risk factors of re-intervention.
Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Lei
L
Zhang
Department of Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Jian
J
Zhou
Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Qingsheng
Q
Lu
Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Zhiqing
Z
Zhao
Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Junmin
J
Bao
Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Zaiping
Z
Jing
D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D000792:Angiography; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D002681:China / Q000453:epidemiology; D057867:Endoleak / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
aortic dissection; endovascular repair; re-intervention