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 RR4. Stent-Graft Placement for Aneurysmal Degeneration After Long-Term Medical Therapy for Type B Aortic Dissection Results in Volumetric Gain of the True Lumen and False Lumen Regression

​Jean Marie Ruddy1, Bradley G. Leshnower1, Paul Reisenman1, James G. Reeves1, Luke P. Brewster2, Yazan Duwayri1, Edward P. Chen1, Ravi K. Veeraswamy1
1Emory University, Atlanta, GA; 2Atlanta VAMC, Atlanta, GA.

OBJECTIVES: Despite optimal medical therapy of uncomplicated Type B aortic dissections (TBAD), true lumen narrowing and aneurysmal degeneration of the false lumen can occur over the long-term (>6 months). The efficacy of thoracic stent-grafts (TEVAR) for aortic remodeling when placed at late time points remains controversial. We studied post-TEVAR aortic volumetric changes in these patients.

METHODS: Utilizing tomographic scans, volumes of multiple aortic compartments were calculated including the stented true lumen (STL), peri-stented false lumen (SFL), true lumen from distal stent to celiac axis (infra stent true lumen, ISTL) and the corresponding false lumen (ISFL). Cross-sectional areas were calculated at one centimeter intervals, collated, and volumetric ratios were derived from pre-operative values.
RESULTS: From 2004-2011, 21 patients met inclusion criteria. The time from index dissection to TEVAR was 197 days or greater. The left subclavian artery was covered in 71.4% of cases. Best-fit line statistical regression analysis of volumetric change demonstrated increases in ISTL and total TL volumes by 55% and 38%, respectively (p<0.05) at one year (Figure 1A and 1B). SFL and ISFL volumes decreased by 41% and 32%, respectively (p<0.05) (Figure 1C and 1D).
CONCLUSIONS: TEVAR for aneurysmal degeneration after long-term medical therapy of TBAD results in volumetric gain of the true lumen and false lumen regression.
AUTHOR DISCLOSURES: L. P. Brewster: Nothing to disclose; E. P. Chen: Nothing to disclose; Y. Duwayri: Nothing to disclose; B. G. Leshnower: Nothing to disclose; J. G. Reeves: Nothing to disclose; P. Reisenman: Nothing to disclose; J. Ruddy: Nothing to disclose; R. K. Veeraswamy: Nothing to disclose.

Posted April 2013

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