Early and midterm outcomes of thoracic endovascular aortic repair (TEVAR) for acute and chronic complicated type B aortic dissection

Abstract

Thoracic endovascular aortic repair (TEVAR) in the current era has been chosen as a dominant and minimally invasive treatment for complicated aorta dissection. This study aimed to assess safety and feasibility of TEVAR in acute and chronic type B aortic dissection.Between January 2011 and December 2013, 85 patients with complicated type B aortic dissection undergoing TEVAR were divided into acute aortic dissection (AAD) (n = 60) group and chronic aortic dissection (CAD) group (n = 25). Computed tomography was used to evaluate postoperative changes in maximal aortic diameter and true and false lumen diameters at 3 levels during a mean follow-up period of 26.4 ± 15.6 months.The technical success rate was 100%. In-hospital and 30-day rates of death were 3.3% in acute group and 0 in chronic group. Postdischarge rates of type I leak, type II leak, and retrograde type A dissection were 6.7%, 5.2%, and 3.4% (acute) and 0%, 4.0%, and 4.0% (chronic), respectively. The maximal aorta diameter remained stable in all the 3 levels in both acute and chronic group. The cumulative freedom from all-cause mortality at 3 years was similar in acute and chronic groups (89.5% vs 95.5%, P = .308). The cumulative freedom from aortic-related mortality was also not significantly different in the acute and chronic groups (92.8% vs 95.2%, P = .531). In the thoracic aorta, TEVAR treatment resulted in a significant increase in true lumen (TL) diameter and decrease in false lumen (FL). However, in the abdominal aorta, TEVAR did not lead to significant change in TL and FL diameters. The rates of complete thrombosis thoracic false lumens were better than that in the abdominal false lumen.TEVAR was a safe and effect therapy for complicated acute and chronic type B dissection with low early and mid-term mortality and morbidity.

TEVAR for complicated and uncomplicated type B aortic dissection—Systematic review and meta‐analysis

“…The total number of patients included in the analysis was 16,104 and data was extracted from 89 studies 4–92 . Among them, 7772 patients were categorized as co‐TBAD and 8352 as un‐TBAD.…”

Outcomes from the Gore Global Registry for Endovascular Aortic Treatment in patients undergoing thoracic endovascular aortic repair for type B dissection

“…The presented data compare favorably with the mortality rates reported by other recent studies. 11,12,[14][15][16][17] The 2-year overall survival rate was 93% for those with acute uncomplicated TBAD and 83% for those with all other categories of TBAD. The unifying feature of the patients with a statistically significant decrease in their freedom from all-cause mortality (acute complicated TBAD, chronic complicated TBAD, and chronic uncomplicated TBAD) presumably resulted from the presence of a complicated presentation, because most physicians would not treat a truly uncomplicated chronic dissection.…”

<p>Surgical Outcomes And Postoperative Descending Aorta Morphologic Remodeling After Thoracic Endovascular Aortic Repair For Acute And Chronic Type B Aortic Dissection</p>

“…The disease course, pathological changes and progression levels of dissection observed in chronic TBAD were considerably different from those observed during the acute phase, and these differences in the natural process of TBAD may influence the outcomes of its treatment 7,21–25. Several studies have described results related to changes in the diameter of the aorta in acute and chronic TBAD before and after TEVAR treatment,21,22 but no study has focused on the effects of different stages on overall morphological parameters, including the TR, OR, MR, RoC and TI, which are related to several distal stent-graft complications 26–28. Our analysis of 63 patients with acute TBAD and 23 patients with chronic TBAD demonstrates that having chronic TBAD is associated with an adverse morphology before TEVAR.…”