Proposed classification of endoleaks after endovascular treatment of Stanford type-B aortic dissections
| Autor: | Mel J Sharafuddin, Zlatko Pozeg, Jeanette H. Man, Giuseppe Papia, T. Brett Reece, Ross Milner, Brian G. Peterson, Bilal Shafi |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Consensus Endoleak Treatment outcome MEDLINE 030204 cardiovascular system & hematology Endovascular therapy Risk Assessment 03 medical and health sciences Aortic aneurysm Blood Vessel Prosthesis Implantation 0302 clinical medicine Aneurysm Blood vessel prosthesis Risk Factors Terminology as Topic medicine Humans Radiology Nuclear Medicine and imaging 030212 general & internal medicine Endovascular treatment Aortic Aneurysm Thoracic business.industry Endovascular Procedures General Medicine medicine.disease Surgery Blood Vessel Prosthesis Aortic Dissection Treatment Outcome Cardiothoracic surgery Chronic Disease Stents Cardiology and Cardiovascular Medicine business |
| Zdroj: | Vascular. 27(6) |
| ISSN: | 1708-539X |
| Popis: | Objectives Despite two decades of experience, no dedicated classification system exists to document and prognosticate patterns of endoleak encountered after endovascular therapy of type-B aortic dissection. This nomenclature gap has led to inconsistent management and underreporting of significant findings associated with adverse outcomes after endovascular treatment of type-B aortic dissection. Our goal was to propose a reproducible and prognostically relevant classification. Methods A multidisciplinary team of seven experienced open and endovascular aortic surgeons was assembled to provide consensus opinion. Extensive literature review was conducted. Deficiencies in the current classification approach of the various patterns of persistent filling of false lumen after endovascular therapy were identified. Results Our focus was to categorize high-risk and low-risk subgroups within endoleaks after endovascular treatment of type-B aortic dissection. In this classification, type-Ia endoleak refers to persistent filling of the false lumen in an antegrade manner. Causes include failure to cover the primary entry tear and sizing or technical related proximal seal failure. False lumen filling via distal entry tears is classified as type Ib endoleak, which is further sub-classified into b1 (major branch-related tears), and b2 (multiple small branches related tears). Retrograde ascending aortic dissection and stent graft-induced new entry were classified as type-I endoleaks (type-Ir and type-Is, respectively). Another focus was reclassification type-II endoleaks, with type-IIa endoleak referring to conventional retroleak from one or more posterior branches and type-IIx referring to retroleak from major branches (visceral or left subclavian arteries). Conclusions The majority of endoleaks after endovascular treatment of type-B aortic dissection are related to persistent or new filling of the false lumen. We propose a new false lumen-based classification schema for endoleaks occurring after endovascular therapy of type-B aortic dissection. |
| Databáze: | OpenAIRE |
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