PC022 Thoracic Endovascular Repair for Acute Complicated Type B Aortic Dissections

Abstract

This study assessed in-hospital mortality and midterm results of emergency thoracic endovascular aortic repair (TEVAR) stent grafting for patients with life-threatening complications of acute type B aortic dissections (acTBD). Between March 2001 and Sept 2016, 53 patients (38 men; mean age, 55 ± 13) with an acTBD were treated with TEVAR for malperfusion (55%), aortic rupture (15%), or persistent untreatable pain (30%) as a sign of pending rupture. Four patients (8%) had undergone previous aortic surgery. Technical success (coverage of the primary tear site) was achieved in 48 patients (91%). Overall hospital mortality rate was 9% (n = 5). Causes of death were rupture during the procedure or on the first postinterventional day in two patients and redissection (ascending aorta n = 2, descending aorta n = 1) with consequent aortic rupture after TEVAR in the remaining three. Permanent neurologic dysfunction occurred in 3 patients (stroke n = 1, paraplegia n = 2). Nineteen patients (36%) developed early endoleaks (type Ia, n = 5; type Ib, n = 11; type II, n = 2; type Ib plus II, n = 1) and were observed throughout the postinterventional period. These seven patients (37%) needed secondary endovascular intervention (n = 3) or conventional surgery (n = 4) due to aortic progression (mean interval after procedure 92 ± 56 months). Secondary endoleaks were observed in nine patients with consequent reintervention in three patients. The actuarial survival was 88%, 76%, and 58% at 1, 5, and 10 years, respectively. Freedom from treatment failure at 1, 5, and 10 years (including reintervention, aortic rupture, device-related complications, aortic-related death, or sudden, unexplained late death) was 76 %, 74%, and 74%, respectively. TEVAR in the treatment of acute complicated type B aortic dissection proves to be an excellent treatment modality in this high risk patient cohort. Refinements, especially in stent design and application, may further reduce the rate of endoleaks and improve the prognosis of patients in this life-threatening situation.