Efficacy of the Stripped AFX Aortic Cuff as a Scaffolding Bare Stent to Facilitate the Expansion of the Thoracoabdominal and Visceral Aorta during Thoracic Endovascular Aortic Repair for Complicated Stanford Type B Aortic Dissection.

ABSTRACT

Purpose: During thoracic endovascular aortic repair for complicated Stanford type B aortic dissection, large bare stent placement for the abdominal aorta is sometimes necessary. In smaller abdominal aortic diameter cases, we used the stripped AFX aortic cuff as a scaffolding bare stent rather than the Zenith Dissection Endovascular Stent, which is a commercially available, large bare stent. In this study, we evaluated the feasibility of the stripped AFX aortic cuff and experiments were conducted to compare the stripped AFX and the Zenith Dissection Endovascular Stent. Material and Method: The type B aortic dissection patients treated with thoracic endovascular aortic repair using stripped AFX at three institutions between January 2014 and December 2017 were retrospectively reviewed. Clinical data, including technical success, perioperative complication, and overall survival, were evaluated. The experiment assessed the chronic outward force that reflected the load acting on the artery wall from the stent. Result: Eight cases (seven males) were reviewed. The median (interquartile range, IQR) age of the patients was 60 years (46.3-70.3). The technical success rate was 100%, and no perioperative complications were observed. The median (IQR) follow-up period was 28.9 months (17.5-31.5). During the follow-up, one patient died of septic shock unrelated to aortic events. The median (IQR) diameter of the stripped AFX on the last follow-up CT was 23.5 mm (21.9-25.0). The chronic outward force of the Zenith Dissection Endovascular Stent was two to three times that of the stripped AFX. Conclusions: The stripped AFX aortic cuff is feasible and safe as a scaffolding stent during thoracic endovascular aortic repair for Stanford Type B aortic dissection.