Analysis of outcomes of acute type B aortic dissection after thoracic endovascular aortic repair

Abstract

To compare the outcomes of complicated and uncomplicated acute type B aortic dissection (C-ATBD, U-ATBD) after thoracic endovascular aortic repair (TEVAR) and to evaluate the safety and efficacy of TEVAR in patients with U-ATBD. Between February 2011 and December 2013, sixty patients with type B aortic dissection were treated with TEVAR and were divided into C-ATBD group (n = 42) and U-ATBD group (n = 18). Postoperative complications and aortic remodeling were analyzed based on the clinical outcomes and computed tomography scans performed before and after operation. The median follow up time was 21.7 (14.0-31.6) months. The 3 years cumulative all-cause survival rate was 85.4% in the C-ATBD group and 100% in the U-ATBD group without significant difference (χ² = 2.52, P = 0.11). The incidence of postoperative complications including type I a endoleak, stent graft-induced distal redissection and retrograde type A aortic dissection were equivalent in the two groups. The aortic enlargement rates at each level and false lumen regression rates on each aortic segment were similar between the two groups. At the level just distal to the celiac artery, there were significant interaction effects on the maximum total aortic diameter and false lumen diameter changes between time and group (P = 0.01, P = 0.02). C-ATBD group showed a tendency of expansion of maximum total aortic diameter and false lumen diameter compared to the U-ATBD group. The acceptable early and midterm outcomes are similar between the two groups after TEVAR. U-ATBD group has a more favorable aortic remodeling than C-ATBD group. TEVAR is feasible and safe for the treatment of U-ATBD.