Risk-Stratified Timing of Thoracic Endovascular Aortic Repair for Complicated Type B Aortic Dissection with Acute...

To evaluate a Rutherford classification-based protocol for determining the timing of thoracic endovascular aortic repair (TEVAR) in patients with complicated Type B aortic dissection (coTBAD) and acute limb ischemia (ALI) and to assess the effectiveness of a TEVAR-first revascularization approach.

From October 2016 to February 2020, 33 consecutive patients with coTBAD and ALI were included in this retrospective study. Based on intervention timing, patients were classified into an ultraearly group (TEVAR within 24 hours of admission, n = 20) and an early group (TEVAR after 24 hours; median, 48 hours; n = 13). Demographics, in-hospital mortality, complications, and limb revascularization outcomes were compared.

Overall in-hospital mortality was 9.1% (3/33), with all fatalities in the ultraearly group (15.0%, 3/20) and none in the early group (0/13, P = .261). This outcome is consistent with the significantly more severe Rutherford classification in the ultraearly group (all IIb/III) than in the early group (all I/IIa, P < .001). TEVAR as first-line treatment successfully achieved limb revascularization in 93.9% (31/33) of cases. Only 2 ultraearly group patients required additional revascularization. During a median 82-month follow-up, 2 nonaortic deaths occurred (1 per group), and the sole amputation was in the ultraearly group.

This single-center study demonstrates that a TEVAR-first strategy was highly effective, achieving successful limb reperfusion in the vast majority of patients. A risk-adapted strategy, utilizing ultraearly (≤24 hours) or early (within 72 hours) TEVAR based on Rutherford classification, was feasible and associated with acceptable overall outcomes.