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Endovascular treatment of type B aortic dissection: the challenge of late success
Claudia Maria Rodrigues Alves1, José Honório Palma da Fonseca, José Augusto Marcondes de Souza
1Department of Cardiothoracic Surgery, Federal University of São Paulo, Paulista School of Medicine, São Paulo, Brazil. cmralves@uol.com.br
Insights
Thoracic endovascular aortic repair (TEVAR) shows excellent initial results for type B aortic dissection. However, long-term outcomes require further investigation due to potential late complications and interventions, necessitating randomized trials.
Area of Science:
- Cardiovascular Surgery
- Vascular Endovascular Therapy
- Aortic Disease Management
Background:
- Thoracic endovascular aortic repair (TEVAR) is a treatment option for select type B aortic dissection patients.
- Limited data exists on the long-term outcomes of TEVAR for type B aortic dissection.
- Previous studies exhibit heterogeneity in patient demographics, indications, and devices used.
Purpose of the Study:
- To evaluate the in-hospital outcomes and late follow-up results of TEVAR in patients with complicated or symptomatic type B aortic dissection.
- To assess the long-term efficacy and safety of a specific TEVAR device in this patient cohort.
Main Methods:
- A cohort of 106 patients with classic complicated or symptomatic type B aortic dissection underwent TEVAR between 1997 and 2004.
- Seventy-three patients were included for analysis of in-hospital outcomes and late follow-up.
- Data collected included technical success, clinical success, in-hospital mortality, complications, and long-term event rates.
Main Results:
- Technical success rate was 99%, with a clinical success rate of 83%.
- In-hospital mortality occurred in 5 patients; 3 required urgent surgical conversion.
- Neurologic complications, including paraplegia, occurred in 5 patients. Late failure criteria were met by 37% of patients, with survival rates exceeding 80% at 2 years.
Conclusions:
- TEVAR demonstrates excellent initial outcomes for both acute and chronic type B aortic dissection.
- Event-free survival declines over time, often necessitating re-interventions.
- Survival rates appear comparable to less complex treatments, but randomized studies are needed to confirm TEVAR's definitive benefit.
Background:
Thoracic endovascular aortic repair of type B aortic dissection is a therapeutic option for selected patients. However, late outcomes of this intervention are virtually unknown, and the series already published are heterogenous regarding demographics, indications, and type of devices.
Methods:
From 1997 to 2004, 106 patients exclusively with classic complicated or symptomatic type B aortic dissection were treated with thoracic endovascular aortic repair, using the same device. We present in-hospital outcomes and late follow-up for 73 patients.
Results:
Technical success was achieved for 99% of patients, and the clinical success rate was 83% (exclusion of the false lumen, no early death or surgical conversion). In-hospital death occurred in 5 patients, 2 of them after surgical conversion. Three patients required urgent surgical conversion. Neurologic complications occurred in 5 patients (1 case of paraplegia). The average time of follow-up was 35.9 +/- 28.5 months. During follow-up, 37% of patients initially successfully treated reached a failure criterion (new endovascular or surgical intervention in the same aortic segment or death due to aortic or unknown cause). Kaplan-Meier curve showed late survival rates higher than 80% in 2 years.
Conclusions:
Patients with both acute and chronic type B aortic dissection had excellent initial results with thoracic endovascular aortic repair. Although event-free survival rates decreased gradually with time owing to the frequent need for new interventions, survival curves were comparable to those for less complex patients undergoing clinical or surgical treatment. Randomized studies are required to establish the actual benefit of this new approach.
