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Original Articles

Factors Portending Endoleak Formation After Thoracic Aortic Stent-Graft Repair of Complicated Aortic Dissection

Daniel Y. Sze, MD, PhD; Maurice A.A.J. van den Bosch, MD, PhD; Michael D. Dake, MD; D. Craig Miller, MD; Lawrence V. Hofmann, MD; Robin Varghese, MD; S. Chris Malaisrie, MD; Pieter J.A. van der Starre, MD, PhD; Jarrett Rosenberg, PhD and R. Scott Mitchell, MD

From the Division of Interventional Radiology (D.Y.S., M.A.A.J.B., M.D.D., L.V.H.), Department of Cardiothoracic Surgery (M.D.D., D.C.M., R.V., S.C.M., R.S.M.), Department of Anesthesia (P.J.A.S.), and Department of Biostatistics (J.R.), Stanford University Medical Center, Stanford, Calif.

Correspondence to Daniel Sze, MD, PhD, H-3646 Stanford University Medical Center, 300 Pasteur Road, Stanford, CA 94305-5642. E-mail dansze{at}stanford.edu

Received September 4, 2008; accepted December 31, 2008.

Background— Endoleaks after stent-graft repair of aortic dissections are poorly understood but seem substantially different from those seen after aneurysm repair. We studied anatomic and clinical factors associated with endoleaks in patients who underwent stent-graft repair of complicated type B aortic dissections.

Methods and Results— From 2000 to 2007, 37 patients underwent stent-graft repair of acute (14 days; n=23), subacute (15 to 90 days; n=10) or chronic (>90 days; n=4) complicated type B aortic dissections using the Gore Thoracic Excluder (n=17) or TAG stent-grafts (n=20) under an investigator-sponsored protocol. Endoleaks were classified as imperfect proximal seal, flow through fenestrations or branches, or complex (both). Variables studied included coverage of the left subclavian artery, aortic curvature, completeness of proximal apposition, dissection chronicity, and device used. Endoleaks were found during follow-up (mean, 22 months) in 59% of patients, and they were associated with coverage of the left subclavian artery (complex, P<0.001), small radius of curvature (type 1 and complex, P=0.05), and greatest length of unapposed proximal stent graft (complex, P<0.0001). During follow-up, 10 endoleaks resolved spontaneously, 6 required reintervention for false lumen dilatation, and 2 were stable without clinical consequences.

Conclusions— Endoleaks are common after stent-graft repair of aortic dissection and may lead to false lumen enlargement necessitating reintervention. Anatomic complexities such as acute aortic curvature and covered side branches were associated with endoleaks, illustrating the need for dissection-specific device development.

Key Words: aorta • dissection • surgery • complications

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CLINICAL PERSPECTIVE

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Factors Portending Endoleak Formation After Thoracic Aortic Stent-Graft Repair of Complicated Aortic Dissection

Daniel Y. Sze, Maurice A.A.J. van den Bosch, Michael D. Dake, D. Craig Miller, Lawrence V. Hofmann, Robin Varghese, S. Chris Malaisrie, Pieter J.A. van der Starre, Jarrett Rosenberg, and R. Scott Mitchell
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