Endovascular Therapy for Nonischemic vs Ischemic Complicated Acute Type B Aortic Dissection

Area of Science:

• Vascular Surgery
• Cardiovascular Imaging
• Interventional Cardiology

Background:

• Complicated acute type B aortic dissection (cATBAD) presents significant management challenges.
• End-organ ischemia is a critical factor influencing outcomes in cATBAD.
• Thoracic endovascular aortic repair (TEVAR) is an evolving treatment modality for aortic pathologies.

Purpose of the Study:

• To evaluate the safety and efficacy of TEVAR in patients with cATBAD.
• To compare outcomes between cATBAD patients with and without end-organ ischemia.
• To identify factors contributing to successful TEVAR in cATBAD.

Main Methods:

• A single-center retrospective study of 64 patients undergoing TEVAR for cATBAD (November 2010 - December 2017).
• Patients were categorized into ischemic (n=25) and non-ischemic (n=39) cohorts based on end-organ hypoperfusion.
• Outcomes including technical success, mortality, complications, and reinterventions were analyzed.

Main Results:

• Technical success was achieved in 97% of patients.
• No significant differences in early or late outcomes were observed between ischemic and non-ischemic groups.
• Higher 30-day mortality (16% vs 5%) and major complications occurred in the ischemic group, though not statistically significant.
• Early intervention (mean 2.3 days) in the ischemic group and branch vessel stenting were noted.

Conclusions:

• TEVAR is a safe and effective treatment for cATBAD.
• Early intervention and direct visceral reperfusion through branch vessel stenting are crucial for favorable outcomes in ischemic cATBAD.
• TEVAR offers comparable results for both ischemic and non-ischemic cATBAD presentations.