Aspects on Imaging and Endovascular Treatment of Aortic Dissection and Aneurysm

• Main Author: Eriksson, Mats-Ola
• Format: Doctoral Thesis
• Language: English
• Published: Uppsala universitet, Enheten för radiologi 2013
• Subjects: Aneurysms; aorta; stents; ultrasound; colour Doppler; vascular; interventional; aortic dissection; complicated; TEVAR; EVAR; re-intervention; survival; thrombosis; false lumen; aortic remodelling
• Online Access: http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-187464; http://nbn-resolving.de/urn:isbn:978-91-554-8559-7

Aortic aneurysm and dissections are potentially life threatening conditions. The advent of endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR) has reduced perioperative mortality and morbidity and are now established therapy methods for treatment of aortic disease. Adequate pre- and intraoperative imaging is important for optimal results in endovascular procedures. However, the standard use of CT and angiography may not always be sufficient to provide necessary information required for treatment, and complementary techniques are warranted in selected cases. TEVAR in acute complicated type B aortic dissections is proven effective in several reports, but long-term clinical outcome and aortic remodelling are still not fully evaluated. Intravascular phased array imaging (IPAI) was used in patients undergoing EVAR and TEVAR for aortic aneurysm and dissection. The combined information from IPAI and fluoroscopy allowed exact positioning of the stent graft. The colour Doppler function facilitated detection of blood-flow in relevant arteries during and after the procedures, and it also facilitated control of ceased flow in excluded false lumens or aneurysms. Clinical early and long-term results after TEVAR for acute complicated type B aortic dissection were investigated in all patients treated between 1999 and 2009 at UppsalaUniversityHospital. Results were favourable regarding survival and permanent neurological complications. Long-term follow-up of aortic morphological changes in the same patient group showed overall significant reduction of aortic and false lumen diameters, and an increase of true lumen diameter. Total thrombosis of the false lumen occured more often in patients with DeBakey IIIa aortic dissection, than in IIIb. In conclusion, IPAI may be a complementary tool to traditional imaging modalities in EVAR and TEVAR in selected cases. Long-term clinical outcome is excellent with favourable aortic remodeling after TEVAR in patients with acute complicated type B aortic dissection.