Risk factors of reintervention after endovascular treatment of type B acute and subacute aortic dissections

Abstract

The treatment of type B aortic dissections is not driven by well defined guidelines. At the time of diagnosis these dissections can be complicated by rupture or organ or limb malperfusion, which require an emergency surgical treatment, or not complicated. In these cases, optimal medical care only was recommended in first intention. The ADSORB and INSTEAD-XL studies recently led us to change our therapeutic attitude by showing the superiority of TEVAR associated with the optimal medical care compared to medical care only in terms of aortic remodeling, healing of the false lumen, and mortality related to the pathology aortic. Studies highlighted several risk factors for a poor prognosis at the time of the diagnosis, including the maximum aortic diameter, the laminated aspect of the true lumen, the principal main entry tear size, or the patency of the false lumen, which contributed to define the population needing TEVAR in association with the best medical care. These risk factors were measured at the time of the diagnosis, i.e. before the medical or surgical treatment. The literature also reported 25% - 50% reintervention rates for the patients who survived the acute phase. The aim of our study was to determine the risk factors of survival without secondary aortic intervention of the patients presenting with a type B aortic dissection, complicated or not, and treated in the 90 days of the diagnosis by TEVAR with coverage of the principal main entry tear.