TEVAR Confers Greater Survival vs Medical Therapy in Uncomplicated Type B Aortic Dissection

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Submitted on Thu, 12/13/2018 - 23:00

Thoracic endovascular aortic repair (TEVAR) is associated with a greater survival benefit compared with medical therapy in patients with uncomplicated type B aortic dissection (UTBAD), according to research published in the Journal of Vascular Surgeryand presented at the 31st Annual Meeting of the Eastern Vascular Society, held October 5-8, 2017.

“The mechanism by which TEVAR may have a favorable impact on survival is by covering the entry tear, leading to false lumen thrombosis and prevention of aneurysmal degeneration,” the researchers explained in their study. “By prevention of aneurysmal degeneration and by initiation of false lumen thrombosis, prevention of recurrent dissection TEVAR may improve long-term survival as demonstrated in this study and others.”

Study investigators retrospectively analyzed 2000-2010 patient data from the California Office of Statewide Hospital Planning Development database, including only adult patients with acute UTBAD (mean age, 66±15 years). Patients were stratified based on care received at index admission: medical therapy (n = 8706), open surgical repair (n = 183), and TEVAR (n = 266). While the primary outcome was long-term overall survival, the researchers also evaluated inpatient mortality, major complications (ie, paraplegia, respiratory embarrassment, hemorrhage, sepsis, renal failure, and inpatient mortality), length of stay, and cost.

Open repair was associated with significantly higher mean inpatient costs compared with TEVAR and medical therapy ($200,000 vs $130,000 vs $57,000, respectively; P <.01). Additionally, open repair was also associated with higher inpatient mortality compared with TEVAR and medical therapy (14% vs 7.1% vs 6.3%, respectively; P <.01). The respective 1- and 5-year survival rates were 84% and 60% for medical therapy, 76% and 67% for open repair, and 85% and 76% for TEVAR (P <.01). In the multivariable risk-adjusted analysis, the use of TEVAR was associated with significantly greater survival vs medical therapy (hazard ratio [HR], 0.68; 95% CI, 0.6-0.8; P <.01). No difference was observed between open repair and medical therapy in regard to survival outcomes (HR, 1.0; 95% CI, 0.8-1.3; P <.01). 

Limitations of the study include its retrospective nature, its restrictive analysis of only patients data recorded between 2000-2010, and the lack of data on relevant clinical and anatomic variables.

“This study suggests that TEVAR for UTBAD is a relatively safe and effective approach associated with longer survival,” the researchers concluded. “This study corroborates findings of small, randomized, controlled trials in a real-world setting and helps establish the baseline costs for treating UTBAD, which will help inform cost-effectiveness analyses in the future.”

- Written by Brandon May

Reference:

Iannuzzi JC, Stapleton SM, Bababekov YJ, et al. Favorable impact of thoracic endovascular aortic repair on survival of patients with acute uncomplicated type B aortic dissection. J Vasc Surg. 2018;68(6):1649-1655.