Midterm results of endovascular treatment of complicated acute type B aortic dissection

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 138; no. 3; pp. 625 - 631
• Main Authors: Khoynezhad, Ali, MD, Donayre, Carlos E., MD, Omari, Bassam O., MD, Kopchok, George E., BS, Walot, Irwin, MD, White, Rodney A., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.09.2009; AATS/WTSA; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - surgery; Aorta, Thoracic - surgery; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Aortic Rupture - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis Implantation; Cardiology. Vascular system; Cardiothoracic Surgery; Diseases of the aorta; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Monitoring, Intraoperative; Pneumology; Retrospective Studies; Stents; Surgery, Computer-Assisted; Survival Rate; Treatment Outcome; Vascular Patency; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - methods; Vascular Surgical Procedures - mortality; 33; CT; thoracic endovascular aortic repair; 26; TEVAR; 28; 18; computed tomographic; Acute; Cardiovascular disease; Endovascular route; Result; Arterial disease; Vascular disease; Type; Treatment; Anesthesia; Aortic dissection; Complication; Circulatory system; Cardiology; Aortic disease
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2009.04.044

Objectives The operative mortality and morbidity of patients with complicated acute type B aortic dissection remain high. The endovascular approach has been proposed as a potential alternative. The purpose of this study is to review the contemporary outcome of patients undergoing endovascular treatment for complicated acute type B aortic dissection. Methods A retrospective analysis of 28 patients undergoing endovascular interventions for acute type B aortic dissection was performed. Kaplan–Meier survival analysis was used for statistical computation. Results Indications for emergency endografting were rupture in 4 (14%) patients, severe lower body malperfusion in 8 (29%) patients, visceral/renal malperfusion in 7 (25%) patients, persistent chest pain despite proper anti-impulsive therapy in 5 (18%) patients, uncontrollable hypertension in 1 (4%) patient, and acute dilatation of false lumen with impending rupture in 3 (11%) patients. Three (11%) patients died early. Three patients died during follow-up of non–aorta-related causes. Overall survival was 82% and 78% at 1 and 5 years' follow-up, respectively. The aorta-related mortality was 10% for the entire follow-up period. Complete thrombosis of the false lumen in the thoracic aorta was achieved in 22 (85%) members of the surviving cohort, and partial thrombosis was achieved in the remainder. The rate of treatment failure according to Stanford criteria was 18% at 5 years. Mean follow-up was 36 months, and follow-up was complete in 28 (100%) patients. Conclusions Thoracic aortic endografting for complicated acute type B aortic dissection can be performed with a relatively low postoperative morbidity and mortality in experienced hands. The endovascular approach to life-threatening complications of acute type B aortic dissection appears to have a favorable outcome in midterm follow-up.