Treatment of type B aortic dissection: endoluminal repair or conventional medical therapy?
OBJECTIVE
To evaluate the mid-term results of endovascular stent-grafting for type B aortic dissection, in comparison with those of standard medical therapy in uncomplicated cases.


METHODS
Between January 1999 and 2004, among 56 patients (mean age 59.5+/-11.5 years) with type B aortic dissection, hypotensive medical therapy was the only treatment in 28 uncomplicated cases, (group A), while stent-graft implantation was performed in 28 patients with uncontrolled hypertension, persistent pain or evidence of dissection progression or complication (group B). In 14 cases (50%) the procedure was performed in an acute setting. Stent-grafting procedures were monitored with intraoperative trans-esophageal echocardiography and cine-angiography. CT scan and trans-esophageal echocardiography were performed before hospital discharge, at 6 and 12 months and then yearly.


RESULTS
Follow-up (range 1-61 months, average 18.1+/-16.9 months) was 100% complete. In-hospital mortality was 10.7% (three patients, all belonging to Group B; P=0.24). No spinal cord injuries were observed. Early endoleak occurred in one patient (3.5%). Mid-term mortality was lower in Group B, although the difference was not significant (10.7 versus 14.3% in Group A, P=0.71). Follow-up CT scans evidenced complete thrombosis of the false lumen in 75% cases in Group B, 10.7% in Group A (P=0.0001), and an aneurismal dilatation of the descending aorta in 3.5% cases in Group B, 28.5% in Group A (P=0.02).


CONCLUSIONS
Although with still considerable early mortality, endovascular stent-graft implantation is an effective option for the treatment of complicated type B aortic dissection. Endovascular treatment achieved a better mid-term fate of the descending thoracic aorta than medical therapy alone, even in patients with worse preoperative conditions.
Dialetto
Giovanni
G
Department of Cardiothoracic and Respiratory Sciences, Division of Cardiovascular Surgery and Transplants, Second University of Naples, V Monaldi Hospital, 80131 Naples, Italy. gdial@libero.it <gdial@libero.it>
Covino
Franco E
FE
Scognamiglio
Giancarlo
G
Manduca
Sabrina
S
Della Corte
Alessandro
A
Giannolo
Bruno
B
Scardone
Michelangelo
M
Cotrufo
Maurizio
M
D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000401:mortality; D017548:Echocardiography, Transesophageal; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015607:Stents; D014057:Tomography, X-Ray Computed
D000959:Antihypertensive Agents