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Endograft repair of complicated acute type B aortic dissections
J Sobocinski1, N V Dias, L Berger
1Vascular Center, Hôpital Cardiologique, Lille University Hospital, France.
Insights
Endograft repair of complicated acute type B aortic dissection (caTBAD) shows good early survival and promotes aortic remodelling. This thoracic endograft treatment is associated with favorable outcomes in most patients.
Area of Science:
- Vascular Surgery
- Cardiovascular Imaging
- Aortic Disease Management
Background:
- Complicated acute type B aortic dissections (caTBAD) present significant risks, including malperfusion, rupture, and persistent symptoms.
- Traditional medical management may be insufficient for these high-risk patients.
Purpose of the Study:
- To evaluate patient outcomes and aortic remodelling after endograft coverage of the proximal entry tear in caTBAD.
- To assess the effectiveness of thoracic endografts in managing caTBAD.
Main Methods:
- Retrospective study of 52 patients with caTBAD treated with thoracic endografts across three vascular centers.
- Inclusion criteria included malperfusion, impending rupture, large aortic diameter, or uncontrolled symptoms.
- Aortic remodelling assessed via 3D CTA, including maximal aortic diameter and false lumen thrombosis.
Main Results:
- Median follow-up was 25 months; 30-day mortality was 9.6%.
- 12-month survival was 90.4%. Secondary interventions were needed in 7 patients.
- At 12 months, 75% had stable/shrinking aortic diameters, and 86% showed complete false lumen thrombosis.
Conclusions:
- Endograft treatment for caTBAD is linked to favorable early outcomes.
- This approach appears to promote aortic remodelling in the majority of treated patients.
Objectives:
This study aims to assess patient outcomes and aortic remodelling following coverage of the proximal entry tear with an endograft in complicated acute type B aortic dissections (caTBADs).
Material And Methods:
All patients with caTBAD treated with a thoracic endograft in three high-volume vascular centres were retrospectively studied. Inclusion criteria were branch-vessel malperfusion, impending or overt aortic rupture, maximal aortic diameter ≥ 40 mm and persistent pain or uncontrolled hypertension despite maximum pharmacological treatment. Postoperative aortic remodelling was evaluated using computed tomography angiography (CTA) on a three-dimensional (3D) imaging workstation.
Results:
A total of 52 patients (71% male, median age 65 years) were included in the study. Median inclusion criteria per patient were 2 (range 1-4). Branch-vessel malperfusion was diagnosed in 42% and impending aortic rupture in 33% of 52 patients. Median follow-up was 25 months (range 2-109 months). The 30-day mortality rate was 9.6% (5/52); patient survival according to the Kaplan-Meier method was 90.4% at 12 months and 87.6% at 24 months. Secondary interventions were performed in seven patients a median of 3 days after the initial procedure (range 2-865). Imaging follow-up at 12 months was performed in 36 patients (69%): 75% presented stable or shrinking (> 5 mm) maximal aortic diameters and 86% had a completely thrombosed false lumen (vs. 5% before initial procedure) at thoracic level.
Conclusion:
Endograft treatment of complicated caTBAD is associated with favourable early outcomes and possibly promotes aortic remodelling in the majority of patients.
