Staged Hybrid single lumen reconstruction (TIGER) in management of chronic symptomatic complex type B aortic dissection, Techniques and literature review.

Staged Hybrid single lumen reconstruction (TIGER) in management of chronic symptomatic complex type B aortic dissection, Techniques and literature review.:

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Staged Hybrid single lumen reconstruction (TIGER) in management of chronic symptomatic complex type B aortic dissection, Techniques and literature review.

Ann Vasc Surg. 2020 Jan 30;:

Authors: Sultan S, Barrett N, Kamal MH, Tawfick W, Atteia EM, Clarkson K, Alawy M, Hynes N

Abstract

PURPOSE: Endovascular intervention for Chronic Symptomatic Type B Aortic Dissection (CS-TBAD) induces aortic wall stress with negative haemodynamic cardiovascular consequences. CSTBAD risks increasing morbidity and mortality due to septum maturation with significant impact on false lumen modulation, and partial lumen thrombosis conveying the worst outcome. The aim of the TIGER technique is total aortic remodeling with true lumen expansion, false lumen regression and complete thrombosis, and stabilization of overall aortic diameter.

METHODS: We report five cases of aortic dissection with a mean follow-up of 16 months (6-28 months). All had aneurysmal dilation, with three having acute pan aortic dissection and two having CS-TBAD. All were managed by sTaged HybrId sinGle lumEn Reconstruction (TIGER). Our first approach was to create one single lumen from the supra-celiac, infra-diaphragmatic aorta to both common iliac arteries with open surgical patching of the visceral arteries; then we performed a TEVAR three months later.

RESULTS: Three patients required a left subclavian artery chimney graft and one required bilateral subclavian to carotid artery transposition. No spinal drainage was required, and all patients had intraoperative transoesophageal echo for wire guidance. We had no aortic rupture or retrograde type A dissection, and we experienced no renal, visceral, cardiac, pulmonary or spinal complications. All patients, but one, went off their antihypertensive medication. All patients had normal estimated Glomerular Filtration Rate (eGFR) postoperatively, and they all demonstrated accelerated aortic modulation.

CONCLUSION: TIGER was not only effective at the semi-acute stage to initiate remodeling and prevent malperfusion, it also facilitated a straightforward TEVAR at stage 2, which was made easier by avoiding visceral branch stenting. Moreover, it decreased the length of aortic segment, which was stented, thereby avoiding critical shattering, branch dislodgment and visceral compromise; spinal ischaemia; and negative cardiovascular consequences.

PMID: 32007594 [PubMed - as supplied by publisher]