Results of a New Surgical Paradigm: Endovascular Repair for Acute Complicated Type B Aortic Dissection

• DOI: 10.1016/j.athoracsur.2008.04.003
• Publication Date: 2008-06-21T08:14:47Z
• Authors: Wilson Y. Szeto; Michael McGarvey; Alberto Pochettino; G. William Moser; Andrea Hoboken; Katherine Cornelius; Edward Y. Woo; Jeffrey P. Carpenter; Ronald M. Fairman; Joseph E. Bavaria
• Keywords: Male; Aortic Aneurysm, Thoracic; Angioplasty; Middle Aged; Aortography; Risk Assessment; Severity of Illness Index; Survival Analysis; Blood Vessel Prosthesis; 3. Good health; Cohort Studies; Aortic Dissection; 03 medical and health sciences; Postoperative Complications; Treatment Outcome; 0302 clinical medicine; Acute Disease; Humans; Minimally Invasive Surgical Procedures; Female; Aged; Follow-Up Studies; Retrospective Studies

Conventional open repair of acute complicated type B aortic dissection is associated with significant morbidity and mortality. This study examined the results of thoracic endovascular aortic repair (TEVAR) in acute type B aortic dissection complicated with rupture or malperfusion syndrome.From 2004 through 2007, 35 patients (22 men) with acute complicated type B aortic dissection were treated with TEVAR. Indications included rupture in 18 (51.4%) and malperfusion syndrome in 17 (48.6%; mesenteric or renal, 5;lower extremities, 3; both, 9). Three types of endograft devices were used (mean per patient, 1.9 devices). Intravascular ultrasound imaging was used in 15 patients (42.8%). In patients with malperfusion syndrome, distal adjunct procedures to expand the true lumen included infrarenal aortic stents in 4, mesenteric/renal stents in 4, and iliofemoral stents in 7. Follow-up was 93.9% during a period of 18.3 months (range, 3 to 47 months).The mean age was 58.6 +/- 13.4 years. Technical success (coverage of the primary tear site) was achieved in 34 patients (97.1%). Coverage of the left subclavian artery was required in 25 patients (71.4%). Thirty-day mortality was 2.8%. One-year survival was 93.4% +/- 4.6%. Complications included permanent renal failure (2.8%), stroke (2.8%), spinal cord ischemia (transient [5.7%], permanent [(2.8%]), and vascular access (14.2%). The mean intensive care unit and hospital stay were 4.7 +/- 2.6 and 16.7 +/- 12.0 days, respectively.Endovascular repair of acute complicated type B aortic dissection is associated with low morbidity and mortality and has emerged as the surgical therapy of choice.