Endovascular management of aortic dissection (2023 – CME) – online course

Description

Authors: T. Kratimenos

Reviewers: T. Bilhim, P. Gkoutzios, M. Hamady, C. Nice, P. Reimer, D. Tsetis

This course corresponds to chapter 2.2.1.1.3 Acute aortic syndromes and aneurysmal disease in the European Curriculum and Syllabus for IR.

Abstract

Aortic dissection (AoD), together with intramural haematoma (IMH) and penetrating aortic ulcer (PAU), represent a group of emergency conditions under the term of Acute Aortic Syndrome (AAS). AoD is characterized by the development of an intimal flap that divides the aorta in a true and a false lumen. Abrupt intense chest pain is the most common presenting symptom of acute AoD and is classified as type A dissection when ascending aorta is involved and type B dissection in the absence of ascending aorta involvement. For type A dissections, the first treatment option is an open surgical repair. Type B dissection is further classified as complicated and uncomplicated. For acute complicated type B AoD cases, thoracic endovascular aortic repair (TEVAR) is the first choice, with different kinds of endoprosthesis currently available. Endovascular aortic repair has demonstrated an ability to prevent late aortic complications in uncomplicated type B dissections also. TEVAR is not recommended in patients with connective tissue disease except as a bail-out procedure. Despite a successful endovascular procedure, patients require a combination of medical therapy, clinical and imaging follow-up postoperatively. CT angiography is the gold standard method both for preoperative diagnosis and post-TEVAR follow-up. Preoperative planning can minimize procedural-related complications. Postoperative imaging follow-up can prevent endoprosthesis-related complications and identify aortic dilatation and aneurysm formation due to residual false lumen patency. A multidisciplinary team with 24/7 availability and modern infrastructures are necessary.

Learning objectives

• Know the pathological spectrum and the factors predisposing to aortic dissection, e.g., atherosclerosis, hypertension, connective tissue disorders, arterial inflammatory conditions, bicuspid aortic valve, and pregnancy
• Know the natural history of aortic dissection, including acute and chronic phases, the potential for late aneurysm formation and the implications for treatment
• Recognize the symptoms and physical signs associated with aortic dissection and its complications
• Be able to identify the typical signs of the true and false lumen of a dissection on catheter angiography, CTA and MRA.
  • Recognize the difference between a static and dynamic type of dissection
• Define the anatomical information required in case selection and planning, including:
  • The site and extent of the primary intimal tear
  • The level of the distal re-entry site
  • Extent of involvement and compromise of significant branch vessels – extent and diameter of any associated aortic aneurysm
  • Condition and dimensions of the proximal and distal sealing zones
• Classify aortic dissection and:
  • Define the indications for medical treatment as opposed to surgical intervention
  • Define the indications for the use of aortic stent grafts in acute or chronic aortic dissection
  • Define the indications for the use of alternative endovascular interventions such as fenestration and/or bare stent placement in order to restore patency in compromised branch vessels
• Understand the advantages and limitations of endovascular stent grafts for aortic dissections with specific attention to:
  • Morbidity and mortality in comparison to open repair
  • Durability of current devices
• Financial implications – Quality of life

Further information

This course covers a basic level of IR knowledge and is designed for trainees, students or young consultants aiming to acquire essential knowledge or prepare for the EBIR exam. Thereby, it is tailored to the European Curriculum and Syllabus for IR and corresponds to chapter 2.2.1.1.3 Acute aortic syndromes and aneurysmal disease.

The format of the course is interactive and easy to use, including texts, graphics, videos and a quiz to support your learning. The course duration is around one hour and is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to award 1.5 European CME credit (ECMEC). The CME accreditation for this course will expire on November 09, 2025. A non-CME accredited version of the course will remain available for two more years.

The acquired CME Certificate will be available in the myCIRSE area under CIRSE Academy.

The enrolment period of this course is linked to the validity of the All-Access Pass.

Release date: November 2023