Advancements in the treatment of chronic thoracoabdominal aortic dissection_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 FU Weiguo ^1,2,3

1. Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P. R. China;
2. Fudan University Institute of Vascular Surgery, Shanghai 200032, P. R. China;
3. National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China;

Corresponding author：

FU Weiguo, Email: fu.weiguo@zs-hospital.sh.cn

Keywords：

chronic aortic dissection; thoracic endovascular arotic repair; endovascular graft

DOI：

10.7507/1007-9424.202404023

Video：

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Aortic dissection is a disease with high mortality rates. Due to the urgency of time, the diagnosis, treatment processes, and strategies of acute aortic dissection follow specific guidelines. However, patients with chronic aortic dissection are often neglected. Choosing the best medication therapy and surgical interventions remains challenging, and there is still a lack of guideline recommendations. With the improvement of imaging diagnostic methods for aortic diseases, the progress of endovascular surgical techniques, and the development of new endovascular graft devices in recent years, clinical data of the treatment of chronic aortic dissection is also gradually increasing. This article summarized the current new technologies and clinical research results for the diagnosis and treatment of chronic aortic dissection, aiming to provide new suggestions for the diagnosis and treatment of chronic aortic dissection.

Citation： FU Weiguo. Advancements in the treatment of chronic thoracoabdominal aortic dissection. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(6): 641-644. doi: 10.7507/1007-9424.202404023 Copy

1.	Papakonstantinou PE, Benia D, Polyzos D, et al. Chronic thoracic aortic dissection: how to treat, when to intervene. Life (Basel), 2022, 12(10): 1511. doi: 10.3390/life12101511.
2.	Sampson UKA, Norman PE, Fowkes FGR, et al. Estimation of global and regional incidence and prevalence of abdominal aortic aneurysms 1990 to 2010. Glob Heart, 2014, 9(1): 159-170.
3.	Fleischmann D, Afifi RO, Casanegra AI, et al. Imaging and surveillance of chronic aortic dissection: A Scientific Statement from the American Heart Association. Circ Cardiovasc Imaging, 2022, 15(3): e000075. doi: 10.1161/HCI.0000000000000075.
4.	Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
5.	Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/ APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension, 2018, 71(6): 1269-1324.
6.	JCS Joint Working Group. Guidelines for diagnosis and treatment of aortic aneurysm and aortic dissection (JCS 2011): digest version. Circ J, 2013, 77(3): 789-828.
7.	Cooper M, Hicks C, Ratchford EV, et al. Diagnosis and treatment of uncomplicated type B aortic dissection. Vasc Med, 2016, 21(6): 547-552.
8.	Genoni M, Paul M, Jenni R, et al. Chronic beta-blocker therapy improves outcome and reduces treatment costs in chronic type B aortic dissection. Eur J Cardiothorac Surg, 2001, 19(5): 606-610.
9.	Chen SW, Chan YH, Lin CP, et al. Association of long-term use of antihypertensive medications with late outcomes among patients with aortic dissection. JAMA Netw Open, 2021, 4(3): e210469. doi: 10.1001/jamanetworkopen.2021.0469.
10.	Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J, 2020, 41(1): 111-188.
11.	Angeloni E, Vitaterna A, Pirelli M, et al. Effects of statin therapy on ascending aorta aneurysms growth: A propensity-matched analysis. Int J Cardiol, 2015, 191: 52-55.
12.	Salata K, Syed M, Hussain MA, et al. Statins reduce abdominal aortic aneurysm growth, rupture, and perioperative mortality: A systematic review and meta-analysis. J Am Heart Assoc, 2018, 7(19): e008657. doi: 10.1161/JAHA.118.008657.
13.	Masaki N, Kumagai K, Sasaki K, et al. Suppressive effect of pitavastatin on aortic arch dilatation in acute stanford type B aortic dissection: analysis of STANP trial. Gen Thorac Cardiovasc Surg, 2018, 66(6): 334-343.
14.	Peng S, Xu LW, Che XY, et al. Atorvastatin inhibits inflammatory response, attenuates lipid deposition, and improves the stability of vulnerable atherosclerotic plaques by modulating autophagy. Front Pharmacol, 2018, 9: 438. doi: 10.3389/fphar.2018.00438.
15.	Lusini M, Nenna A, Chello C, et al. Role of autophagy in aneurysm and dissection of the ascending aorta. Future Cardiol, 2020, 16(5): 517-526.
16.	Preventza O, Le Huu A, Olive J, et al. Endovascular repair of the ascending aorta: the last frontier. Ann Cardiothorac Surg, 2022, 11(1): 26-30.
17.	Mertens R, Arriagada I, Valdés F, et al. Endovascular treatment of type B aortic dissection. Rev Med Chil, 2008, 136(11): 1431-1438.
18.	Lortz J, Leinburger F, Tsagakis K, et al. Distal stent graft induced new entry: risk factors in acute and chronic type b aortic dissections. Eur J Vasc Endovasc Surg, 2019, 58(6): 822-830.
19.	Liu F, Zhang H, Rong D, et al. Protocol for Guo’s aortIc Arch recoNstrucTion: a prospective, multicentre and single-arm study to evaluate the safety and efficacy of the WeFlow-Arch modular inner branch stent-graft system for aortic arch lesions (GIANT study). BMJ Open, 2022, 12(10): e063245. doi: 10.1136/bmjopen-2022-063245.
20.	Sultan I, Dufendach K, Kilic A, et al. Bare metal stent use in type B aortic dissection may offer positive remodeling for the distal aorta. Ann Thorac Surg, 2018, 106(5): 1364-1370.
21.	Lin Y, Dong S, Luo J, et al. Satisfactory long-term outcomes of thoracic endovascular aortic repair with a bare stent for acute complicated type B aortic dissections. J Endovasc Ther, 2021, 28(2): 275-282.
22.	Wang R, Kan Y, Yang M, et al. Clinical results and aortic remodeling after endovascular treatment for complicated type B aortic dissection with the "Fabulous" stent system. Front Cardiovasc Med, 2022, 9: 817675. doi: 10.3389/fcvm.2022.817675.
23.	Lombardi JV, Gleason TG, Panneton JM, et al. STABLEⅡ clinical trial on endovascular treatment of acute, complicated type B aortic dissection with a composite device design. J Vasc Surg, 2020, 71(4): 1077-1087.
24.	Rohlffs F, Tsilimparis N, Fiorucci B, et al. The Candy-Plug Technique: technical aspects and early results of a new endovascular method for false lumen occlusion in chronic aortic dissection. J Endovasc Ther, 2017, 24(4): 549-555.
25.	Ogawa Y, Nishimaki H, Chiba K, et al. Candy-plug technique using an excluder aortic extender for distal occlusion of a large false lumen aneurysm in chronic aortic dissection. J Endovasc Ther, 2016, 23(3): 483-486.
26.	Kölbel T, Carpenter SW, Lohrenz C, et al. Addressing persistent false lumen flow in chronic aortic dissection: the knickerbocker technique. J Endovasc Ther, 2014, 21(1): 117-122.
27.	Oikonomou K, Kopp R, Katsargyris A, et al. Outcomes of fenestrated/branched endografting in post-dissection thoracoabdominal aortic aneurysms. Eur J Vasc Endovasc Surg, 2014, 48(6): 641-648.
28.	Oikonomou K, Kasprzak P, Katsargyris A, et al. Mid-Term results of fenestrated/branched stent grafting to treat post-dissection thoraco-abdominal aneurysms. Eur J Vasc Endovasc Surg, 2019, 57(1): 102-109.
29.	Isselbacher EM. Thoracic and abdominal aortic aneurysms. Circulation, 2005, 111(6): 816-828.

1. Papakonstantinou PE, Benia D, Polyzos D, et al. Chronic thoracic aortic dissection: how to treat, when to intervene. Life (Basel), 2022, 12(10): 1511. doi: 10.3390/life12101511.
2. Sampson UKA, Norman PE, Fowkes FGR, et al. Estimation of global and regional incidence and prevalence of abdominal aortic aneurysms 1990 to 2010. Glob Heart, 2014, 9(1): 159-170.
3. Fleischmann D, Afifi RO, Casanegra AI, et al. Imaging and surveillance of chronic aortic dissection: A Scientific Statement from the American Heart Association. Circ Cardiovasc Imaging, 2022, 15(3): e000075. doi: 10.1161/HCI.0000000000000075.
4. Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
5. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/ APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension, 2018, 71(6): 1269-1324.
6. JCS Joint Working Group. Guidelines for diagnosis and treatment of aortic aneurysm and aortic dissection (JCS 2011): digest version. Circ J, 2013, 77(3): 789-828.
7. Cooper M, Hicks C, Ratchford EV, et al. Diagnosis and treatment of uncomplicated type B aortic dissection. Vasc Med, 2016, 21(6): 547-552.
8. Genoni M, Paul M, Jenni R, et al. Chronic beta-blocker therapy improves outcome and reduces treatment costs in chronic type B aortic dissection. Eur J Cardiothorac Surg, 2001, 19(5): 606-610.
9. Chen SW, Chan YH, Lin CP, et al. Association of long-term use of antihypertensive medications with late outcomes among patients with aortic dissection. JAMA Netw Open, 2021, 4(3): e210469. doi: 10.1001/jamanetworkopen.2021.0469.
10. Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J, 2020, 41(1): 111-188.
11. Angeloni E, Vitaterna A, Pirelli M, et al. Effects of statin therapy on ascending aorta aneurysms growth: A propensity-matched analysis. Int J Cardiol, 2015, 191: 52-55.
12. Salata K, Syed M, Hussain MA, et al. Statins reduce abdominal aortic aneurysm growth, rupture, and perioperative mortality: A systematic review and meta-analysis. J Am Heart Assoc, 2018, 7(19): e008657. doi: 10.1161/JAHA.118.008657.
13. Masaki N, Kumagai K, Sasaki K, et al. Suppressive effect of pitavastatin on aortic arch dilatation in acute stanford type B aortic dissection: analysis of STANP trial. Gen Thorac Cardiovasc Surg, 2018, 66(6): 334-343.
14. Peng S, Xu LW, Che XY, et al. Atorvastatin inhibits inflammatory response, attenuates lipid deposition, and improves the stability of vulnerable atherosclerotic plaques by modulating autophagy. Front Pharmacol, 2018, 9: 438. doi: 10.3389/fphar.2018.00438.
15. Lusini M, Nenna A, Chello C, et al. Role of autophagy in aneurysm and dissection of the ascending aorta. Future Cardiol, 2020, 16(5): 517-526.
16. Preventza O, Le Huu A, Olive J, et al. Endovascular repair of the ascending aorta: the last frontier. Ann Cardiothorac Surg, 2022, 11(1): 26-30.
17. Mertens R, Arriagada I, Valdés F, et al. Endovascular treatment of type B aortic dissection. Rev Med Chil, 2008, 136(11): 1431-1438.
18. Lortz J, Leinburger F, Tsagakis K, et al. Distal stent graft induced new entry: risk factors in acute and chronic type b aortic dissections. Eur J Vasc Endovasc Surg, 2019, 58(6): 822-830.
19. Liu F, Zhang H, Rong D, et al. Protocol for Guo’s aortIc Arch recoNstrucTion: a prospective, multicentre and single-arm study to evaluate the safety and efficacy of the WeFlow-Arch modular inner branch stent-graft system for aortic arch lesions (GIANT study). BMJ Open, 2022, 12(10): e063245. doi: 10.1136/bmjopen-2022-063245.
20. Sultan I, Dufendach K, Kilic A, et al. Bare metal stent use in type B aortic dissection may offer positive remodeling for the distal aorta. Ann Thorac Surg, 2018, 106(5): 1364-1370.
21. Lin Y, Dong S, Luo J, et al. Satisfactory long-term outcomes of thoracic endovascular aortic repair with a bare stent for acute complicated type B aortic dissections. J Endovasc Ther, 2021, 28(2): 275-282.
22. Wang R, Kan Y, Yang M, et al. Clinical results and aortic remodeling after endovascular treatment for complicated type B aortic dissection with the "Fabulous" stent system. Front Cardiovasc Med, 2022, 9: 817675. doi: 10.3389/fcvm.2022.817675.
23. Lombardi JV, Gleason TG, Panneton JM, et al. STABLEⅡ clinical trial on endovascular treatment of acute, complicated type B aortic dissection with a composite device design. J Vasc Surg, 2020, 71(4): 1077-1087.
24. Rohlffs F, Tsilimparis N, Fiorucci B, et al. The Candy-Plug Technique: technical aspects and early results of a new endovascular method for false lumen occlusion in chronic aortic dissection. J Endovasc Ther, 2017, 24(4): 549-555.
25. Ogawa Y, Nishimaki H, Chiba K, et al. Candy-plug technique using an excluder aortic extender for distal occlusion of a large false lumen aneurysm in chronic aortic dissection. J Endovasc Ther, 2016, 23(3): 483-486.
26. Kölbel T, Carpenter SW, Lohrenz C, et al. Addressing persistent false lumen flow in chronic aortic dissection: the knickerbocker technique. J Endovasc Ther, 2014, 21(1): 117-122.
27. Oikonomou K, Kopp R, Katsargyris A, et al. Outcomes of fenestrated/branched endografting in post-dissection thoracoabdominal aortic aneurysms. Eur J Vasc Endovasc Surg, 2014, 48(6): 641-648.
28. Oikonomou K, Kasprzak P, Katsargyris A, et al. Mid-Term results of fenestrated/branched stent grafting to treat post-dissection thoraco-abdominal aneurysms. Eur J Vasc Endovasc Surg, 2019, 57(1): 102-109.
29. Isselbacher EM. Thoracic and abdominal aortic aneurysms. Circulation, 2005, 111(6): 816-828.

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