Outcomes of TEVAR for uncomplicated subacute type B aortic dissection in the IRAD registry

Thoracic endovascular aortic repair (TEVAR) in uncomplicated type B acute aortic dissection (TBAAD) remains controversial. Compared to best medical therapy (BMT), TEVAR has demonstrated benefits in aortic remodeling; however, this intervention does include procedural related risks.

The International Registry of Acute Aortic Dissection (IRAD) database was queried from January 1996 to September 2023 for all uncomplicated TBAAD. Patients receiving subacute (15-90 days) TEVAR (sTEVAR) and BMT were included. Baseline comorbidities were recorded. The primary outcome was survival at 4 years. Secondary outcomes included delayed aortic interventions, progression of aortic disease, new dissection, re-hospitalization, rupture, and stroke.

During the study period, 1373 uncomplicated TBAAD patients were entered into the registry and had follow-up data available. Sixty-three patients (4.6%) underwent sTEVAR and 1310 (95.4%) received BMT. Four-year survival was similar between the groups (sTEVAR 87% vs BMT 84%, p=0.925). At three years, the sTEVAR group had higher rates of new dissection (13.9% vs 4.8%, p=0.002), all within 1 year of TEVAR. Progression of dissection, aneurysmal degeneration, reintervention, rupture, stroke, and re-hospitalization were comparable between groups.

As compared to BMT, sTEVAR had similar rates of survival. New dissection was higher in the sTEVAR group. TEVAR may have a role in subacute uncomplicated TBAAD, and ongoing randomized trials are essential to understand which patients benefit from intervention.