Outcome of thoracic endovascular aortic repair in complicated type-B dissections

Abstract

Background Complicated type-B dissections are catastrophic aortic lesions. Thoracic endovascular aortic repair (TEVAR) is less invasive than open surgery in treating these lesions. Morbidity and mortality are less in TEVAR than in surgery. The anatomical and clinical suitability need to be assessed in each patient. Institutional experience may also influence the outcome. Purpose The aim of this study was to evaluate the efficiency and safety of TEVAR in treating complicated type-B-dissection patients. These results are also compared between DeBakey type-IIIa and type-IIIb dissections. Patients and methods This is a prospective, nonrandomized, dual-center cohort study. Fifteen patients with complicated type-B aortic dissections were treated with TEVAR. The study was performed in two tertiary referral centers. It began in July 2015 and ended in May 2017. Six of the 15 patients suffered from DeBakey IIIa dissections, while nine of the 15 patients suffered from DeBakey IIIb dissections. The dissection onset was acute in one (6%) patient, subacute in two (13%) patients, and chronic in 12 (80%) patients. Follow-up computed tomography angiography was done 1 month, 6 months, and 1 year after the procedure. Results All-cause and aorta-specific mortality were both 0%. TEVAR caused false lumen thrombosis in 87% of cases. The endograft patency rate was 100%. The aortic diameter did not increase further in 87%. Device migration did not occur in any patient. Type IA endoleak occurred in one (6%) patient. Postimplantation syndrome occurred in one (6%) patient. Groin-wound infection occurred in one (6%) patient. A groin hematoma occurred in two (13%) patients. No strokes, paraplegia, or retrograde type-A dissections occurred. Conclusion TEVAR leads to excellent aorta-specific survival and delayed disease progression. TEVAR is safe and efficient in treating complicated type-B aortic dissection. There are no differences between DeBakey IIIa and IIIb dissections in the safety and efficiency of TEVAR.