Using certain clinical and anatomic features as a guide, it may be possible to predict whether patients with medically managed type B aortic dissection (TBAD) will benefit from early thoracic endovascular aortic repair (TEVAR).
Patients with acute uncomplicated TBAD are typically managed medically because data show favorable 1-year survival when compared open replacement of the descending thoracic aorta However, as time passes, patients with medically managed TBAD have a high incidence of aorta-related complications that often require surgical intervention.
Little data exists to guide clinicians in determining who will benefit from early TEVAR though. Thus, researchers undertook a retrospective study of 254 patients with medically managed acute TBAD. The patients (65% men) had an average age of 66.3 years and presented from January 2000 to December 2013.
Patients were followed for a mean of 6.8 years with computed tomography imaging, during which 38% of the patients needed an aortic intervention, 12% needed an early intervention, and 26% were treated during late follow up for aneurysmal degeneration.
The researchers identified several predictors of late aortic intervention, including entry tear >10 mm, total aortic diameter >40 mm at time of presentation, false lumen diameter >20 mm, and increase in total aortic diameter >5 mm between serial imaging studies. They also found that complete thrombosis of the false lumen was protective against late operative intervention.
“It is clear from the literature that TEVAR has proved to be an effective way to manage patients with acute complicated TBAD with improved aortic remodeling and long-term survival compared with medical therapy alone. Thus, it is intuitive that the indications for TEVAR would be expanded to include patients with uncomplicated TBAD who are at high risk for aorta-related complications in the future,” the study’s authors concluded.
Schwartz SI, Durham C, Clouse WD, et al. Predictors of late aortic intervention in patients with medically treated type B aortic dissection. J Vasc Surg. 2018;67(1):78-84.