☆ 4.6 Article Proceedings Paper

Midterm Results After Endovascular Treatment of Acute, Complicated Type B Aortic Dissection

ANNALS OF THORACIC SURGERY (2010)

Journal

ANNALS OF THORACIC SURGERY

Volume 90, Issue 5, Pages 1444-1449

Publisher

ELSEVIER SCIENCE INC

DOI: 10.1016/j.athoracsur.2010.06.076

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Abstract

Background. The purpose of this study was to assess the efficacy and midterm results of endovascular treatment of acute, complicated type B aortic dissection. Methods. Between January 2001 and February 2010, 32 patients (7 women, 25 men) with acute, complicated type B aortic dissection (mean age, 56 years; range, 35 to 83 years), defined as either aortic rupture, malperfusion, intractable pain, or uncontrolled hypertension, underwent endovascular stent graft placement with either the Gore Excluder/TAG device (n = 11), Medtronic Talent/Valiant device (n = 16), Bolton Relay (n = 2), or a combination of these stents (n = 3). Follow-up was 94% complete and averaged 26 +/- 23 months. Results. Technical feasibility and success with deployment proximal to the entry tear was 87%, requiring partial or total coverage of the left subclavian artery (LSA) in 9 patients (28%). Hospital mortality was 12% +/- 11% (95% confidence limit) with 2 late deaths (17 and 98 months after implant). Causes of hospital death included rupture in 2, retrograde type A dissection in 1, and multiorgan failure in 1 patient. Three patients (11%) experienced new neurologic complications (2 paraparesis and 1 hemiparesis). Six patients with malperfusion required branch vessel stenting. Furthermore, 2 had an early type Ia endoleak. Actuarial survival at 1 and 5 years was 81% and 76%, respectively. Freedom from treatment failure at 1 and 5 years (including reintervention, aortic rupture, device-related complication, and aortic related death) was 78% and 61%, respectively. Conclusions. Endovascular stent-graft placement in acute, complicated type B aortic dissection proves to be a promising alternative therapeutic treatment modality in this relatively difficult patient cohort. Refinements, especially in stent design and application, may further improve the prognosis of patients in this life-threatening situation. (Ann Thorac Surg 2010; 90: 1444-9) (C) 2010 by The Society of Thoracic Surgeons

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Endovascular treatment of complicated versus uncomplicated acute type B aortic dissection

Domenico Spinelli, Fred A. Weaver, Ali Azizzadeh, Gregory A. Magee, Gabriele Piffaretti, Filippo Benedetto, Charles C. Miller, Harleen K. Sandhu, Dennis R. Gable, Santi Trimarchi

Summary: The study aimed to analyze the outcomes of thoracic endovascular aortic repair for complicated and uncomplicated acute type B aortic dissections. The data from WL Gore's Global Registry for Endovascular Aortic Treatment showed that the 30-day mortality and perioperative complications were equally low for both complicated and uncomplicated type B aortic dissections, and the midterm outcome was positive.

JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY (2023)