title: Technical Aspects of Open Repair for Degenerative Aneurysmal Evolution Despite Early Thoracic Endovascular Repair of Type B Aortic Dissection.
abstract: BACKGROUND
  Closure of the proximal tear by thoracic endovascular aortic repair (TEVAR) at the acute phase appears to be a safe effective treatment to prevent aneurysmal degeneration type B dissection. However, it appears to be inefficient in up to a third of the patient. We report the technical aspects of our experience with patients undergoing secondary open repair after TEVAR for dissecting thoracoabdominal aneurysm despite early closure proximal tear by TEVAR.
  
  
  METHODS
  During a period of 5 years, 96 patients presenting acute type B aortic dissections were treated by TEVAR and followed-up in our institution. Among them, 5 patients experienced an evolution to a dissecting thoracoabdominal aortic aneurysm. Their demographic data and initial medical conditions, delay to reintervention, operative technical details, perioperative and mid-term outcomes were collected and analyzed.
  
  
  RESULTS
  All 5 patients (4 male, mean age 58 ± 9) were operated under peripheral normothermic bypass without deep circulatory arrest using the thoracic stent graft as an elephant trunk for completion of the proximal anastomosis. In cases of patency, the false lumen was reapproximated in the anastomosis, 6 visceral arteries were revascularized selectively. One patient died at day 1 of perioperative ventricular fibrillation due to an acute myocardial infarction. The 4 others are alive without complication after a median of 30 months, range (13-22).
  
  
  CONCLUSIONS
  In our experience, TEVAR was not only efficient at the acute phase to deal with complications, but in cases of subsequent aneurysmal evolution, it made open repair even easier by avoiding very proximal cross-clamping/anastomosis and circulatory arrest.
authors.affiliation: Department of Cardiovascular Surgery, Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Sonia
authors.initials: S
authors.lastname: Aguir
authors.affiliation: Department of Cardiovascular Surgery, Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; INSERM U970, PARCC, University Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Salma
authors.initials: S
authors.lastname: El Batti
authors.affiliation: Department of Cardiovascular Surgery, Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; INSERM U970, PARCC, University Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Achouh
authors.affiliation: Department of Cardiovascular Surgery, Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; INSERM U970, PARCC, University Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Julia
authors.affiliation: Department of Cardiovascular Surgery, Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Bel
authors.affiliation: Department of Cardiovascular Surgery, Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; INSERM U970, PARCC, University Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Jean-Noël
authors.initials: JN
authors.lastname: Fabiani
authors.affiliation: Department of Cardiovascular Surgery, Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; INSERM U970, PARCC, University Paris Descartes, Sorbonne Paris Cité, Paris, France. Electronic address: jean-marc.alsac@egp.aphp.fr.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Alsac
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D018450:Disease Progression; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome