Endovascular repair or medical treatment of acute type B aortic dissection? A comparison.
BACKGROUND
The aim of this retrospective study was to compare the outcome of thoracic endovascular aortic repair (TEVAR) to that of medical therapy in patients with acute type B aortic dissection (TBD).


METHODS
From July 1996 to April 2008, 88 patients presenting with acute TBD underwent either TEVAR (group A, n=38) or medical therapy (group B, n=50). Indications for TEVAR were intractable pain, aortic branch compromise resulting in end-organ ischemia, rapid aortic dilatation and rupture. Follow-up was performed postinterventionally, at 3, 6 and 12 months and yearly thereafter and included clinical examinations and computed tomography (CT), as well as aortic diameter measurements and assessment of thrombosis.


RESULTS
Mean follow-up was 33 months in group A and 36 months in group B. The overall mortality rate was 23.7% in group A and 24% in group B, where 4 patients died of late aortic rupture. In group A, complications included 9 endoleaks and 4 retrograde type A dissections, 3 patients were converted to open surgery and 2 needed secondary intervention. None of the patients developed paraplegia. In group B, 4 patients were converted to open surgery and 2 to TEVAR. The maximal aortic diameter increased in both groups. Regarding the extent of thrombosis, our analyses showed slightly better overall results after TEVAR, but they also showed a tendency towards approximation between the two groups during follow-up.


CONCLUSIONS
TEVAR is a feasible treatment option in acute TBD. However, several serious complications may occur during and after TEVAR and it should therefore be reserved to patients with life-threatening symptoms.
Chemelli-Steingruber
I
I
Department of Radiology, Innsbruck Medical University, Austria.
Chemelli
A
A
Strasak
A
A
Hugl
B
B
Hiemetzberger
R
R
Jaschke
W
W
Glodny
B
B
Czermak
B V
BV
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis / Q000628:therapy*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008875:Middle Aged; D015607:Stents; D014656:Vascular Surgical Procedures / Q000379:methods*
D005343:Fibrinolytic Agents