Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Vascular Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China.
J Endovasc Ther. 2021 Dec;28(6):860-870. doi: 10.1177/15266028211028213. Epub 2021 Jul 7.
Aortic intimal intussusception is well described in the natural progression of type A aortic dissection. Only 3 cases of aortic intimal intussusception were reported to be related to thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection. In our study, we are reporting a rare but potentially fatal complication, the intraoperative stent-graft (SG)-induced aortic intimal intussusception (ISAII); this study reports a series of endovascular repair for ISAII cases. By presenting the ISAII definition, the diagnostic steps to rule out or to identify the condition, and the techniques to resolve it, we intended to raise the awareness of this severe complication, so that physicians can adapt to overcome the complications while performing TEVAR.
ISAII was defined as the partial or circumferential disruption of the distal intimal flap as an intraoperative complication of endovascular treatment. From January 2014 to June 2020, 1,096 patients underwent TEVAR for Stanford type B aortic dissection at our hospital. Among them, 14 ISAII complications were witnessed. All these patients underwent endovascular repair for ISAII lesions, and their data were extracted for analysis.
The ISAII lesions were classified into 3 types according to their location in different aortic segments: type I, ISAII was limited within the intended SG coverage segment; type II, ISAII occurred after SG introduction or deployment, and the detached intimal flap extended beyond the intended SG coverage segment but did not affect the abdominal aortic visceral branches; type III, ISAII occurred during SG introduction or deployment, and the detached intimal flap descended to the abdominal aortic segment with visceral branches. Our results showed ISAII as a rare complication with an incidence of 1.28% (14/1096), and endovascular repair for all types of ISAII is an effective treatment. With a mean follow-up of 27.36 months (range 5-71 months), all the ISAII lesions were stable, and all the major aortic branches, SGs, and bare stents were patent.
The management of this potentially devastating intraoperative complication relies on accurate diagnosis and prompt management. Our results suggested that endovascular repair for ISAII is effective and durable for correcting this complication.
[Formula: see text].
主动脉内膜内陷在急性 A 型主动脉夹层的自然病程中已有很好的描述。仅报告了 3 例与胸主动脉腔内修复术（TEVAR）治疗 Stanford B 型主动脉夹层相关的主动脉内膜内陷（ISAII）病例。在我们的研究中，我们报告了一种罕见但可能致命的并发症，即术中支架移植物（SG）引起的主动脉内膜内陷（ISAII）；本研究报告了一系列用于治疗 ISAII 的血管内修复病例。通过提出 ISAII 的定义、排除或识别该疾病的诊断步骤以及解决该疾病的技术，我们旨在提高对这种严重并发症的认识，以便医生在进行 TEVAR 时能够适应并克服这些并发症。
ISAII 被定义为血管内治疗的术中并发症，即远端内膜瓣的部分或环状破裂。2014 年 1 月至 2020 年 6 月，我院共对 1096 例 Stanford B 型主动脉夹层患者进行了 TEVAR 治疗。其中，14 例发生 ISAII 并发症。所有这些患者均接受了针对 ISAII 病变的血管内修复治疗，并提取其数据进行分析。
根据病变在不同主动脉节段的位置，ISAII 病变分为 3 型：Ⅰ型，ISAII 局限于预期 SG 覆盖段内；Ⅱ型，ISAII 发生在 SG 引入或展开后，分离的内膜瓣延伸超出预期 SG 覆盖段，但不影响腹部主动脉内脏分支；Ⅲ型，ISAII 发生在 SG 引入或展开过程中，分离的内膜瓣下降至有内脏分支的腹主动脉段。我们的结果显示，ISAII 是一种罕见的并发症，发生率为 1.28%（14/1096），对所有类型的 ISAII 进行血管内修复是一种有效的治疗方法。平均随访 27.36 个月（5-71 个月），所有 ISAII 病变均稳定，所有主要主动脉分支、SG 和裸支架均通畅。
这种潜在破坏性的术中并发症的处理依赖于准确的诊断和及时的处理。我们的结果表明，血管内修复治疗 ISAII 是一种有效且持久的纠正这种并发症的方法。
