Thoracic endovascular aortic repair for type B aortic dissection

Thoracic endovascular aortic repair (TEVAR) has emerged as an acceptable off-label treatment modality for aortic dissection. We report our experience in endovascular treatment of this disease with an emphasis on defining the patterns of morbidity.

We retrospectively reviewed all (n = 90) patients with thoracic aortic disease who received a TEVAR between February 2005 and December 2007. Aortic dissection was the indication in 23 (26%) patients (48% acute, 52% chronic; Stanford A 17%, Stanford B 83%). For the purposes of this report, we concentrated on the type B dissection (17 patients). Eighty-two percent of the patients were symptomatic on presentation, and 56% of cases were performed either urgently or emergently.

Technical success was achieved in 100% of cases, with an average operative time of 178 + or - 119 min. Forty-seven percent required a left subclavian bypass. Thirty-day mortality was 5.5% and morbidity was 12%. Postoperative complications included respiratory failure in 28% of cases, gastrointestinal symptoms in 11%, and cerebrovascular symptoms in 5.5%. No renal failure occurred. While cerebrospinal fluid drain was used in 35% of cases, transient spinal cord ischemia was observed in 5.5%. Average length of stay was 13 + or - 12 days; 63% of patients were discharged home, 12% required rehabilitation, and 25% were discharged to a skilled nursing facility. There was no association between outcome and mode of presentation or anatomic extent.

Aortic dissection remains a challenging clinical entity, and the advent of TEVAR has improved outcomes but still carries considerable morbidity, with distinct patterns between mode of presentation and anatomic extent.