Thoracic endovascular aortic repair (TEVAR) has acceptable morbidity and mortality rates for treatment of chronic type B aortic dissection (cTBD), and changes in sac diameter are promising, researchers said in a study published in the Journal of Vascular Surgery.
Open surgery has been the traditional, “gold standard” method of treating cTBD but still is accompanied by the risk of significant morbidity and mortality. TEVAR has been increasingly used for type B aortic dissection, but there have not been large amounts of data available on outcomes for complicated cTBD.
To address this research gap, the investigators conducted a retrospective cohort study of 4,713 patients identified by the Vascular Quality Initiative (VQI) registry. The patients received TEVAR treatment from July 2010 to November 2015, including 125 procedures that were repairs for cTBD.
The study found that:
- Patients had a median age of 65 years and a median aneurysm diameter of 5.5 cm.
- Upon presentation, 62 (49.6%) patients were asymptomatic, 57 (45.6%) were symptomatic, and 6 (4.8%) had rupture.
- Patients remained hospitalized for a median of 8 days.
- Median fluoroscopy time was 17.3 minutes.
- The distal landing zone was aortic zone 4 in 27 (21.6%) and aortic zone 5 and distal in 98 (78.4%) patients.
- In 123 patients (98.4%), the device was successfully delivered.
- One patient was converted to open repair.
- A type IA endoleak was present in 2 (1.6%), type IB endoleak in 2 (1.6%), and type II endoleak in 2 (1.6%) patients.
Complications were also detailed:
- Perioperative complications included stroke in 1 (0.8%), respiratory complications in 6 (4.8%), and spinal cord ischemia symptoms present at discharge in 3 (2.4%) patients.
- In-hospital mortality occurred in three (2.4%) patients.
- Reintervention was required in two (1.6%) patients for false lumen perfusion and in two (1.6%) patients for extension of the dissection.
“TEVAR for cTBD has acceptable rates of perioperative morbidity and mortality. Changes in sac diameter in the short term and midterm are promising. The extent of aortic coverage appears to not affect aortic diameter changes,” the researchers concluded. They added, “Robust midterm and long-term data are needed to determine whether this approach is durable.”
Conway AM, Qato K, Mondry LR, Stoffels GJ, Giangola G, Carroccio A. Outcomes of thoracic endovascular aortic repair for chronic aortic dissections. J Vasc Surg. 2018;67(5):1345-1352.