The indication and time of treatment of thoracic endovascular aortic repair in acute Stanford B dissection

Abstract

To study the indication of thoracic endovascular aortic repair (TEVAR) in acute Stanford B dissection. From February 2004 to June 2008, 464 cases of Stanford B dissection (391 males and 73 females, age from 26 to 88 with a mean of 56.6 years) underwent TEVAR. Patients were divided into group A (acute, n=298) and group B (chronic, n=166). Risk factors of rupture were evaluated and results were compared between the two groups. The incidence of persistent or recurrent pain and hemothorax in ruptured patients was 83.3% and 94.4%, greater than 10.4% and 14.1% in the non-ruptured patients (P<0.01). The mean maximal diameter of the descending thoracic aorta in the rupture group was 49.4 mm, greater than 35.1 mm in the non-rupture group (P<0.01). Aortic branch vessel ischemia was greatly alleviated after TEVAR. Resolution of the proximal false lumen was 51.7% in group A, 19.5% in group B, and the rate of patent distal false lumen was 59.2% in group A, 79.3% in group B (P<0.01). Four out of 24 cases of intramural hematoma had recurrent dissection. Acute dissection with a patent proximal false lumen is an indication for TEVAR. Intramural hematoma could be given medical treatment under close follow-up. Persistent or recurrent pain, hemothorax, descending thoracic aorta greater than 4.5 cm, or aortic branch vessels ischemia warrant prompt TEVAR.