[Efficacy and safety of emergency tevar for complicated type B aortic dissection with critical acute limb ischemia]

Objective: To evaluate the efficacy and safety of emergency thoracic endovascular aortic repair (TEVAR) as a first-line treatment for complicated type B aortic dissection (coTBAD) presenting with critical acute limb ischemia (ALI). Methods: A retrospective case series analysis was conducted on data from 20 consecutive patients with coTBAD and critical ALI (Rutherford class Ⅱb/Ⅲ) who underwent emergency TEVAR (≤24 hours from admission) at the Department of Vascular Surgery, Second Xiangya Hospital of Central South University between October 2016 and February 2020. There were 19 males and 1 female, with an age of (51.8±14.2) years (range: 30 to 74 years). Data on patient characteristics, perioperative outcomes, and follow-up were collected. The primary endpoint was the success rate of limb revascularization following TEVAR. Secondary endpoints included mortality and the incidence of major complications. Data were analyzed using descriptive statistics and paired sample t-tests. Survival and amputation-free survival were assessed using Kaplan-Meier analysis. Results: The procedure was technically successful in all cases. In-hospital mortality was 15.0% (3/20): two deaths were attributed to concomitant superior mesenteric artery ischemia, and one case resulted from irreversible lower limb ischemia precipitating septic shock and multiorgan failure. TEVAR alone successfully revascularized the lower extremity in 90.0% (18/20) of patients. The follow-up time was(M(IQR)) 80.0(31.5) months (range: 6 to 105 months), 15/17 of survivors maintained favorable limb function. No patient who achieved initial revascularization success required any additional vascular procedures during follow-up; one patient experienced claudication due to lumbar disc herniation, and one underwent amputation. The ankle-brachial index significantly improved from 0.28±0.19 (range: 0 to 0.47) preoperatively to 0.93±0.12 (range:0.81 to 1.05) at the final assessment (t=14.89, P<0.01). Kaplan-Meier analysis showed that the cumulative survival rate was 94.1% at 6 months postoperatively and remained stable through 3 years; similarly, the cumulative amputation-free rate was 94.1% at 1 month postoperatively and was sustained up to 3 years. Conclusions: For patients with coTBAD and critical ALI, an emergency TEVAR-first strategy effectively reverses limb ischemia and obviates the need for additional revascularization in most cases. Mid-to long-term follow-up confirms sustained hemodynamic improvement.