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Updated: Apr 17, 2026
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Propensity adjusted analysis of open and endovascular thoracic aortic repair for chronic type B dissection: a
Guido H W van Bogerijen1, Himanshu J Patel1, David M Williams2
1Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan.
Insights
Optimal treatment for chronic type B aortic dissection (CBAD) remains debated. While both open repair (OAR) and thoracic endovascular aortic repair (TEVAR) offer excellent outcomes, OAR demonstrated improved long-term treatment efficacy in this study.
Area of Science:
- Cardiovascular Surgery
- Thoracic Aortic Disease
- Medical Device Technology
Background:
- Optimal management for chronic type B aortic dissection (CBAD) is controversial, with open repair (OAR) and thoracic endovascular aortic repair (TEVAR) being primary options.
- A comparative analysis is warranted to determine the most effective treatment strategy for CBAD.
- This study evaluates outcomes of OAR versus TEVAR in a cohort of patients requiring intervention for CBAD.
Purpose of the Study:
- To compare the effectiveness and outcomes of open descending aortic repair (OAR) versus thoracic endovascular aortic repair (TEVAR) for chronic type B aortic dissection (CBAD).
- To identify predictors of early and late mortality and treatment failure in patients undergoing intervention for CBAD.
- To assess the long-term efficacy of OAR and TEVAR in managing CBAD.
Main Methods:
- A retrospective analysis of 122 patients who underwent intervention for CBAD between 1993 and 2013.
- Patients were treated with either open descending aortic repair (OAR, n=90) or thoracic endovascular aortic repair (TEVAR, n=32).
- A propensity score was used for multivariable analysis to account for baseline differences between treatment groups.
Main Results:
- Early outcomes (30-day) included 4% mortality, 2% stroke, 3% paraplegia, and 7% renal failure requiring dialysis.
- Visceral aorta intervention and maximum aortic diameter predicted early composite outcomes, but treatment type did not.
- Ten-year survival was 56.2%, predicted by baseline creatinine and peripheral vascular disease, not treatment type.
- Ten-year freedom from aortic rupture or reintervention was 78.3%. OAR showed improved 3-year freedom from treatment failure (96.7%) compared to TEVAR (87.5%, p=0.026).
Conclusions:
- Both open and endovascular approaches can achieve excellent results for CBAD intervention.
- Thoracic endovascular aortic repair (TEVAR) demonstrated a higher rate of treatment failure, suggesting a need for device or technique modification.
- Open repair (OAR) showed superior long-term treatment efficacy compared to TEVAR in this cohort.
Background:
Optimal treatment of chronic type B aortic dissection (CBAD), whether open (open descending aortic repair, OAR) or endovascular (thoracic endovascular aortic repair, TEVAR), is controversial, suggesting a comparative analysis is warranted.
Methods:
One hundred twenty-two of 1,049 patients (1993 to 2013) undergoing descending aortic repair required intervention for CBAD 29.2 ± 34.9 months after the initial acute event and formed the study cohort (mean age 59.7 years). Those with degenerated residual type A dissection were excluded (n = 65). Eighty-eight had extent IIIB CBAD; 11 had intramural hematoma. Indications for surgery included aneurysmal degeneration (n = 105), rupture (n = 8), acute or chronic dissection (n = 8), and extension of dissection (n = 1). Open strategy included descending (n = 71) and thoracoabdominal repair (n = 19), with hypothermic circulatory arrest used in 70 patients. The TEVAR was performed with (n = 2) or without (n = 30) visceral debranching. A treatment strategy propensity score incorporating time since initial acute event, CBAD extent, year of intervention, age, and selected comorbidities was constructed for multivariable analysis.
Results:
Early outcome included the following: 30-day mortality 4% (n = 5); stroke 2% (n = 2); permanent paraplegia 3% (n = 4); renal failure requiring dialysis 7% (n = 8, 5 temporary and 3 permanent); and tracheostomy 3% (n = 4). Visceral aorta intervention (odds ratio [OR] 3.5, p = 0.026) and maximum aortic diameter (OR 1.1, p = 0.001) but not treatment type (p = 0.64) independently predicted an early composite outcome comprised of these variables. Ten-year survival was 56.2%. Baseline creatinine (hazard ratio [HR] 1.7, p < 0.001) and peripheral vascular disease (HR 2.5, p = 0.021), but not treatment type (p = 0.225) predicted late mortality. Ten-year freedom from aortic rupture or need for reintervention was 78.3%. Treatment efficacy was improved after OAR (3-year freedom 96.7% vs TEVAR 87.5%, p = 0.026), and this was confirmed after Cox regression (TEVAR, HR 4.6, p = 0.046).
Conclusions:
Intervention for CBAD can be performed with excellent results, either by an open or endovascular approach. The higher rate of treatment failure after TEVAR warrants modification of current device design or endovascular approach before broad application of this treatment strategy.
