Technique-Based Evaluation of Clinical Outcomes and Aortic Remodelling Following TEVAR in Acute and Subacute Type B Aortic Dissection

• DOI: 10.1007/s00270-020-02749-2
• Publication Date: 2021-01-03T15:02:30Z
• Authors: Jim Zhong; Ahmed Osman; Costa Tingerides; Sapna Puppala; David Shaw; Simon McPherson; Rosemary Darwood; Paul Walker
• Keywords: Adult; Aged, 80 and over; Male; Time Factors; Aortic Aneurysm, Thoracic; Endovascular Procedures; Aorta, Thoracic; Middle Aged; Vascular Remodeling; 3. Good health; Aortic Dissection; Blood Vessel Prosthesis Implantation; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Acute Disease; Humans; Female; Stents; Tomography, X-Ray Computed; Aged; Retrospective Studies

To evaluate the clinical outcomes and aortic remodelling rates following thoracic endovascular aortic repair (TEVAR) for acute or subacute type B aortic dissection (TBAD) based on technique.All TEVARs for acute/subacute TBAD between 01/01/2008 and 01/06/2020 were included. TEVARS were grouped by technique (TEVAR only, PETTICOAT and STABILISE). Aortic remodelling was assessed at three aortic levels on follow-up CT. Thirty-day technical/clinical success rates, re-intervention rates and complications were recorded.A total of 29 patients were included. The median age was 55 years (31-82). The median duration from initial presentation to TEVAR was 7 days (0-84). Intra-procedural complications included one aortic rupture from balloon moulding in a STABILISE case. Thirty-day mortality, stroke, spinal cord ischaemia and visceral ischaemia were 3% (n = 1), 3% (n = 1), 3% (n = 1) and 3% (n = 1), respectively. (All occurred in acute TBAD.) Overall survival was 50.5 months (18-115). Median follow-up was 31 months (1-115). Six patients (21%) required re-intervention, with a median time of 5 months (5-46) from first TEVAR. Overall complete aortic remodelling rates were: 89% at the proximal descending thoracic aorta, 78% at the distal thoracic aorta and 50% at the infra-renal abdominal aorta. At the infra-renal aorta, the STABILISE group (n = 11) had a higher complete aortic remodelling rate (82%) compared to TEVAR alone (n = 12) (20%).Endovascular intervention for acute and subacute TBAD is safe with a high rate of technical success. STABILISE results in higher aortic remodelling at the infra-renal aorta (82%) compared to TEVAR alone (20%) but risks aortic rupture from balloon moulding.