1. Aortic Symposium New York 2012 „Pseudoaneurysm After Endovascular Stent Graft Placement for Treatment of Type B Aortic Dissection“ R.A. Jánosi, M. Bettin, T. Konorza, H. Kälsch, H. Eggebrecht, R. Erbel Department of Cardiology West German Heart Center Essen

2. Patient Characteristics no DPADPAp patients143 (95 %)8 (5 %) male96 (63 %)5 (63 %)0,786 age (y)62,2 ± 12,8 (22-84)60,7 ± 8,7 (48-71)0,746 Time to Treatment (mo)4,3 ± 11,920,3 ± 36,30,251 acute dissection6210,64 stent graft diameter (mm)34,0 ± 5,133,0 ± 1,50,589 stent graft length (mm)153,2 ± 43,1158,1 ± 40,00,753 Angle (°)167,1 ± 12,4148,2 ± 16,5<0,05 reintervention18 (13 %)7 (88 %)*<0,05 Time to reintervention (mo)27,8 ± 24,619,1 ± 15,10,364

3. Characteristics of 8 patients complicated with DPA after Endografting for Type B Dissection p at ie nt AgeInitial IndicationCoexis ting conditi ons Onset time Intervention >diagnosis DPA (mo) Stent graft extension Duration of follow up (mo) DPA (mm) Stent 170Recurrent pain, impending rupture HTN16yes4515x35Valiant 259Recurrent painHTN3yes2722x34Relay 347Recurrent pain, Malperfusion HTN19yes2710x16Valiant 468Recurrent painHTN50yes8039x44Talent 567Recurrent painHTN, MI 76yes10920x34Talent 665Recurrent painHTN, CHD 14yes1313x25Relay 758Recurrent painHTN115refused115-Talent 849Progredient FL- aneurysm HTN26yes269x28Valiant

6. Rate of freedom Reintervention years Distal Pseudoaneurysm Yes No Yes-censored No-censored

9. When passively bent at the arch, the self-expanding stent graft has the inherent tendency to spring back to its initial straight status.

10. When passively bent at the arch, the self- expanding stent graft has the inherent tendency to spring back to its initial straight status.

11. Conclusions Endovascular treatment in chronic type B dissection has a high technical success rate and low mortality Pseudoaneurysm of the thoracic aorta is a rare and potentially fatal condition Potential mechanism: Trauma caused by the semi-rigid stent graft Fragility of the aortic wall and disease progression Excessive radial force due to distal oversizing of the stent graft prosthesis to > 20%  Development of dissection-specific, less-rigid endo- prosthesis

14. Characteristics of 8 patients complicated with DPA after Endografting for Type B Dissection p at ie nt AgeInitial IndicationCoexis ting conditi ons Oversi zing Onset time Intervention >diagnosis DPA (mo) Stent graft extension Duration of follow up (mo) DPA (mm) Stent 170Recurrent pain, impending rupture HTN16yes4515x35Valiant 259Recurrent painHTN3yes2722x34Relay 347Recurrent pain, Malperfusion HTN19yes2710x16Valiant 468Recurrent painHTN50yes8039x44Talent 567Recurrent painHTN, MI 76yes10920x34Talent 665Recurrent painHTN, CHD 14yes1313x25Relay 758Recurrent painHTN115refused115-Talent 849Progredient FL- aneurysm HTN26yes269x28Valiant