Abstract
Few studies support guidelines for the use of thoracic endovascular aortic repair (TEVAR) to address type B aortic dissection (TBAD) coexisting with descending thoracic aortic dissection and aneurysm (dTADA). This cohort study investigated midterm outcomes of TBAD with dTADA (dTADA group, n = 31) and without dTADA (non-dTADA group, n = 98) after TEVAR. Compared with the non-dTADA group, the dTADA group exhibited higher incidences of type Ia endoleak (29.0% vs. 3.1%, P < 0.001) and reintervention (16.1% vs. 5.1%, P = 0.045). The completely thrombosed rate of the thoracic false lumen was significantly lower in the dTADA group than in the non-dTADA group (45.2% vs. 80.6%, P < 0.001). Although the two groups exhibited similar mortality rates, TBAD coexisting with no regressive dTADA after TEVAR was an independent predictor of mortality (HR: 15.52, 95% CI: 1.614–149.233, P = 0.018). Moreover, the change percentages of false lumen retraction and true lumen re-expansion in the dTADA group were significantly inferior to those of the non-dTADA group at levels of 4th, 6th, 8th and 10th thoracic vertebra throughout follow-up. In conclusion, in the presence of preexisting dTADA, the failure of the dTADA to regress after TEVAR is associated with lower survival and a higher risk of reintervention.
Highlights
It has been reported that approximately 14.2–15.7% of aortic dissections are accompanied by descending aortic aneurysms, whereas approximately 1.6–4.9% of descending aortic aneurysms coexist with aortic dissection[1,2,3,4]
Patients were divided into two groups according to whether preoperative type B aortic dissection (TBAD) was accompanied by dissection and aneurysm (dTADA) (Fig. 1A,B) or was not accompanied by dTADA (Fig. 1C,D). dTADA was defined as a minimum cross-sectional diameter of greater than 5 cm in the proximal descending aortic dissection and was regarded as the criterion for dividing the groups in this study
We found that TBAD coexisting with dTADA was associated with higher incidences of partial false lumen (FL) thrombosis, endoleak, secondary intervention, postoperative dTADA and expanding dTADA (Table 2)
Summary
It has been reported that approximately 14.2–15.7% of aortic dissections are accompanied by descending aortic aneurysms, whereas approximately 1.6–4.9% of descending aortic aneurysms coexist with aortic dissection[1,2,3,4]. Guidelines do not clearly describe a therapeutic strategy for TBAD with descending thoracic aortic dissection and aneurysm (dTADA); instead, they recommend that complicated TBAD should be treated with thoracic aortic endovascular repair (TEVAR) or open repair. Guidelines suggest that TEVAR should be performed in cases of aneurysmal dissection of the descending aorta with a maximal diameter ≥5.5 cm and considered for patients with systemic hypertension in a lower threshold of 5 cm, because dissection is associated with significant aortic growth over time[5,6]. TEVAR is an advanced therapy recommended for the management of complicated type B aortic dissection because it significantly reduces morbidity and mortality compared with open repair[7,8]. The purpose of this study was to evaluate the midterm prognosis of TEVAR in treating TBAD coexisting with dTADA
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