Thoracic endovascular repair for acute complicated type B aortic dissections

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Interventional Cardiology

Background:

• Acute complicated type B aortic dissection (acTBD) presents significant mortality risks.
• Emergency treatment is crucial for life-threatening acTBD complications like malperfusion or rupture.
• Thoracic endovascular aortic repair (TEVAR) is an evolving treatment option for acTBD.

Purpose of the Study:

• To evaluate the in-hospital mortality and long-term outcomes of emergency TEVAR in patients with acTBD.
• To assess the safety and efficacy of TEVAR for acTBD management.
• To compare outcomes between different clinical presentations of acTBD treated with TEVAR.

Main Methods:

• Retrospective analysis of 55 patients with acTBD treated with emergency TEVAR between 2001 and 2016.
• Patients were grouped based on clinical presentation: malperfusion/rupture (Group A) vs. pain/enlargement (Group B).
• Data collected included technical success, in-hospital mortality, complications (neurologic dysfunction, endoleaks), and long-term survival and reintervention rates.

Main Results:

• Technical success was achieved in 91% of patients.
• Overall in-hospital mortality was 9%, with significantly higher early mortality in Group A (7%) compared to Group B (2%).
• Long-term survival rates at 5 years were 75%, with 77% freedom from aorta-related death. Freedom from reintervention at 5 years was 63%.

Conclusions:

• Emergency TEVAR is an excellent treatment for high-risk acTBD patients.
• The procedure demonstrates promising midterm and long-term results.
• TEVAR offers a viable option for managing complex aortic dissections.