Endovascular Repair for Type B Aortic Dissection Accompanied by Retrograde Intramural Haematoma

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Interventional Cardiology

Background:

• Type B aortic dissection (TBAD) with retrograde intramural hematoma (RTIMH) presents complex management challenges.
• RTIMH extending to the proximal aorta (zone 0-2) may influence treatment outcomes.
• Thoracic endovascular aortic repair (TEVAR) is an evolving treatment for complex aortic pathologies.

Purpose of the Study:

• To evaluate the outcomes of TEVAR in patients with TBAD and RTIMH involving zone 0-2.
• To compare outcomes between patients with RTIMH involving zone 0 versus those with RTIMH confined to zones 1 and 2.
• To identify factors associated with adverse aortic events (AAEs) after TEVAR.

Main Methods:

• Retrospective multicenter study of 155 patients undergoing TEVAR for TBAD with RTIMH.
• Patients were stratified into two groups: RTIMH involving zone 0-2 (group 1) and RTIMH in zones 1-2 only (group 2).
• Primary endpoint was any AAE, including dissection progression, aorta-related mortality, reintervention, and complications.

Main Results:

• No significant difference in overall AAEs between groups (9.0% total).
• Group 1 patients were younger and had more primary entry tears at the inner aortic arch curvature.
• Freedom from reintervention was significantly lower in group 1 (79.1%) compared to group 2 (93.3%).

Conclusions:

• TEVAR is a viable treatment for selected TBAD patients with RTIMH extending to zone 0.
• Higher reintervention rates in patients with RTIMH propagation into the proximal ascending aorta necessitate vigilant monitoring.
• Close follow-up is crucial for patients with RTIMH involving zone 0 after TEVAR.