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Mid-term Results of Endovascular treatment of Complicated Acute Type B Aortic Dissection
A. Khoynezhad1, C. E. Donayre2, I. Walot2, G. E. Kopchok2, R. A. White2. 1University Of Nebraska Medical Center, Omaha, NE, 2Harbor-UCLA Medical Center, Torrance, CA,
Mid-term Results of Endovascular treatment of Complicated Acute Type B Aortic Dissection
Background: Despite improvement in surgical techniques and advances in peri-operative care, the operative mortality and morbidity for complicated acute type B aortic dissection remains high. Endovascular approach has been proposed as a potential alternative. The goal of this therapy is to prevent aortic rupture, exclude the primary entry site and relieve lower body malperfusion. The Stanford group has documented promising clinical results in a smaller series of patients undergoing endovascular procedures. The purpose of this study is to review the contemporary outcome of patients undergoing endovascular treatment for complicated acute type B aortic dissection.
Methods: Retrospective analysis of patients undergoing endovascular interventions for acute type B aortic dissection in both institutions was performed. Acute dissection was defined within 14 days from acute presentation. In order to have a more homogeneous patient cohort, the retro-A dissections were excluded. Treatment failure was defined as aortic rupture, device mechanical fault, reintervention, aortic-related death or sudden or unexplained late death (Stanford criteria). The Kaplan-Meier survival analysis was used for statistical computation.
Results: Seventy-two endovascular procedures were performed for type B aortic dissection over the last eight years. 28 patients underwent 30 procedures for complicated acute type B aortic dissection. Indications for emergency endografting were rupture in four (14%), severe lower body malperfusion in eight (29%), visceral/renal malperfusion in seven (25%), persistent chest pain despite proper anti-impulsive therapy in five (18%), uncontrollable hypertension in one (4%), acute dilatation of false lumen with impending rupture in three (11%). The patients were in average 62 years old (standard deviation: ± 15, range: 35-88 years). Nineteen (68%) were male and nine female (Table one). Three patients died early (11%). Three patients died in the follow-up of non-aortic related causes. Overall Survival was 82% and 78% at one- and five-year follow-up, respectively (Kaplan-Meier curve). The aorta-related mortality was 11% for entire follow-up. Complete thrombosis of the false lumen in the thoracic aorta was achieved in 22 of surviving cohort (85%), and partial thrombosis in the remainder. The rate of treatment failure according to Stanford criteria was 18% at five years. Mean follow-up was 36 months (standard deviation: ± 27, range: 1-88 months), and follow-up was complete in 28 patients (100%).
Conclusions: Thoracic aortic endografting for complicated acute type B aortic dissection can be performed with a relatively low postoperative morbidity and mortality in experienced centers. Endovascular approach to life-threatening complications of acute type B aortic dissection appears to have a favorable outcome in mid-term follow-up.Table one| Operative time (min) | 152 ± 165 | | ICU days (median) | 4 ± 5.6 | | Hospital days (median) | 8 ± 8.6 | | Renal failure (Creatinine ≥1.8) | 3 (11%) | | Stroke | 1 (4%) | | Paraplegia | 0 | | Sepsis/MODS | 1 (4%) | | Early Mortality | 3 (11%) | | Aorta-related Mortality | 3 (11%) | | Overall Mortality | 6 (21%) | 
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