Early and mid-term results of endovascular repair for type B aortic dissections: A single tertiary center experience

Abstract

Aim: The utility of thoracic endovascular aortic repair (TEVAR) in Type B Aortic dissections (TBAD) continues to advance at a growing rate. The purpose of this research was to investigate our management strategy and early-mid-term outcomes of endovascular procedures for TBAD, in a single tertiary center. Material and Methods: Sixty-six eligible TBAD patients (2 hyperacute complicated, 12 acute complicated and 52 uncomplicated) were enrolled in this single-center, retrospective cohort study between January 2016 and January 2023. The endpoints of the study were technical success, early and late morbidity and mortality, reinterventions throughout the follow-up period, as well as late open conversion. Results: Technical success was achieved in all cases. Early mortality was seen in only 3 patients (4.5%). Only patients with one hyperacute and two acute complicated TBAD (cTBAD) had early death. There was one late mortality in an acute cTBAD patient, who developed retrograde type A dissection two months after TEVAR. The median follow-up period was 26.1±13.7 months. Six reinterventions were performed for extension of dissection or covering the entries distally (9.1%). No endoleak, graft infection or migration were observed. Open surgical repair was performed; however, the patient did not survive. Conclusion: Early results of TEVAR in elective TBAD is trouble-free. Carrying the patients to the subacute phase seems to be the most suitable timing for TEVAR. Anti-stimulus and anti-hypertensive treatment with surveillance programme is mandatory for this patient cohort. Pre-emptive TEVAR has satisfactory results; however, long-term results are mandatory for further recommendations.