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Predictors of outcome after endovascular repair for chronic type B dissection
K Mani1, R E Clough, O T A Lyons
1Department of Vascular Surgery, Guy's and St Thomas NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK. kevin.mani@surgsci.uu.se
Insights
Durability of thoracic endovascular aortic repair (TEVAR) for chronic type B dissection (CD) is challenging. Aortic remodeling, linked to false lumen thrombosis, predicts better survival in CD patients post-TEVAR.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Endovascular Interventions
Background:
- Chronic type B dissection (CD) poses significant risks.
- Thoracic endovascular aortic repair (TEVAR) is an option for CD management.
- Assessing long-term outcomes and predictive factors for TEVAR in CD is crucial.
Purpose of the Study:
- To evaluate the durability of TEVAR in patients with CD.
- To identify factors that predict outcomes after TEVAR for CD.
Main Methods:
- Retrospective analysis of a prospective database of 58 patients undergoing TEVAR for CD (2000-2010).
- Analysis included pre-operative characteristics, operative outcomes, false lumen thrombosis, aortic diameter changes, and survival.
- Mid-term imaging follow-up was performed for 47 patients.
Main Results:
- Perioperative mortality was 5%. Complications included retrograde type A dissection, paraplegia, and transient ischemic attack.
- Estimated 1-year and 3-year survival rates were 89% and 64%, respectively.
- Mid-term survival was significantly higher in patients with aortic remodeling (89% at 3 years) compared to those without (54%), with remodeling associated with false lumen thrombosis.
Conclusions:
- TEVAR for CD presents mid-term durability challenges.
- Aortic remodeling is a key predictor of improved survival after TEVAR in CD.
- Persistence of flow in the false lumen appears to influence aortic remodeling.
Objectives:
To assess the durability of endovascular repair (TEVAR) in chronic type B dissection (CD) and identify factors predictive of outcome.
Design:
Retrospective analysis of a prospective database.
Materials:
Patients undergoing TEVAR for CD at a tertiary referral centre 2000-2010.
Methods:
Analysis of pre-operative characteristics, operative outcome, false lumen thrombosis, aortic diameter and survival.
Results:
58 consecutive patients were included (49 elective, 9 urgent, mean age 66 years). Mean aortic diameter was 6.4 cm (Standard deviation SD 1.3 cm). Three patients died perioperatively (5%, 1 urgent, 2 elective). Complications included retrograde type A dissection (n = 3), paraplegia (1), and transient ischaemic attack (1). Estimated survival (Kaplan-Meier) was 89% (1-year) and 64% (3-years). Forty-seven patients had mid-term imaging follow-up at mean 38 months. Reintervention rate was 15% at 1-year and 29% at 3-years. Aortic diameter decreased in 24, was stable in 15 and increased in 8. Mid-term survival was higher in patients with aortic remodelling (reduction of aortic diameter >0.5 cm; 3-year 89%) than without (54%; Log Rank p = 0.005). Remodelling occurred with extensive false lumen thrombosis.
Conclusion:
Satisfactory mid-term outcome after TEVAR for CD remains a challenge. Survival is associated with aortic remodelling, which is related to persistence of flow in the false lumen.
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