Management of renal arteries in conjunction with thoracic endovascular aortic repair for complicated stanford type b aortic dissection: The Japanese multicenter study (j-predictive study)

Shinichi Iwakoshi, Michael D. Dake, Yoshihito Irie, Yoshiaki Katada, Shoji Sakaguchi, Norio Hongo, Katsuki Oji, Tetsuya Fukuda, Hitoshi Matsuda, Ryota Kawasaki, Takanori Taniguchi, Manabu Motoki, Makiyo Hagihara, Yoshihiko Kurimoto, Noriyasu Morikage, Hiroshi Nishimaki, Eijun Sueyoshi, Kyozo Inoue, Hideyuki Shimizu, Ichiro IdetaTakatoshi Higashigawa, Osamu Ikeda, Naokazu Miyamoto, Motoki Nakai, Takahiro Nakai, Shigeo Ichihashi, Takeshi Inoue, Takashi Inoue, Masato Yamaguchi, Ryoichi Tanaka, Kimihiko Kichikawa

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Management of abdominal branches associated with Stanford type B aortic dissection is controversial without definite criteria for therapy after thoracic endovascular aortic repair (TEVAR). This is in part due to lack of data on natural history related to branch vessels and their relationship with the dissection flap, true lumen, and false lumen. Purpose: To investigate the natural history of abdominal branches after TEVAR for type B aortic dissection and the relationship between renal artery anatomy and renal volume as a surrogate measure of perfusion. Materials and Methods: This study included patients who underwent TEVAR for complicated type B dissection from January 2012 to March 2017 at 20 centers. Abdominal aortic branches were classified with following features: Patency, branch vessel origin, and presence of extension of the aortic dissection into a branch (pattern 1, supplied by the true lumen without branch dissection; pattern 2, supplied by the true lumen with branch dissection, etc). The branch artery patterns before TEVAR were compared with those of the last follow-up CT (mean interval, 19.7 months) for spontaneous healing. Patients with one kidney supplied by pattern 1 and the other kidney by a different pattern were identified, and kidney volumes over the course were compared by using a simple linear regression model. Results: Two hundred nine patients (mean age ± standard deviation, 66 years ± 13; 165 men and 44 women; median follow-up, 18 months) were included. Four hundred fifty-nine abdominal branches at the last follow-up were evaluable. Spontaneous healing of the dissected branch occurred in 63% (64 of 102) of pattern 2 branches. Regarding the other patterns, 6.5% (six of 93) of branches achieved spontaneous healing. In 79 patients, renal volumes decreased in kidneys with pattern 2 branches with more than 50% stenosis and branches supplied by the aortic false lumen (patterns 3 and 4) compared with contralateral kidneys supplied by pattern 1 (pattern 2 vs pattern 1: -16% ± 16 vs 0.10% ± 11, P = .002; patterns 3 and 4 vs pattern 1: -13% ± 14 vs 8.5% ± 14, P = .004). Conclusion: Spontaneous healing occurs more frequently in dissected branches arising from the true lumen than in other branch patterns. Renal artery branches supplied by the aortic false lumen or a persistently dissected artery with greater than 50% stenosis are associated with significantly greater kidney volume loss.

Original languageEnglish (US)
Pages (from-to)455-463
Number of pages9
JournalRadiology
Volume294
Issue number2
DOIs
StatePublished - 2020

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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