Midterm results of endovascular treatment of complicated acute type B aortic dissection.
OBJECTIVE
The operative mortality and morbidity of patients with complicated acute type B aortic dissection remain high. The endovascular approach has been proposed as a potential alternative. The purpose of this study is to review the contemporary outcome of patients undergoing endovascular treatment for complicated acute type B aortic dissection.


METHODS
A retrospective analysis of 28 patients undergoing endovascular interventions for acute type B aortic dissection was performed. Kaplan-Meier survival analysis was used for statistical computation.


RESULTS
Indications for emergency endografting were rupture in 4 (14%) patients, severe lower body malperfusion in 8 (29%) patients, visceral/renal malperfusion in 7 (25%) patients, persistent chest pain despite proper anti-impulsive therapy in 5 (18%) patients, uncontrollable hypertension in 1 (4%) patient, and acute dilatation of false lumen with impending rupture in 3 (11%) patients. Three (11%) patients died early. Three patients died during follow-up of non-aorta-related causes. Overall survival was 82% and 78% at 1 and 5 years' follow-up, respectively. The aorta-related mortality was 10% for the entire follow-up period. Complete thrombosis of the false lumen in the thoracic aorta was achieved in 22 (85%) members of the surviving cohort, and partial thrombosis was achieved in the remainder. The rate of treatment failure according to Stanford criteria was 18% at 5 years. Mean follow-up was 36 months, and follow-up was complete in 28 (100%) patients.


CONCLUSIONS
Thoracic aortic endografting for complicated acute type B aortic dissection can be performed with a relatively low postoperative morbidity and mortality in experienced hands. The endovascular approach to life-threatening complications of acute type B aortic dissection appears to have a favorable outcome in midterm follow-up.
Khoynezhad
Ali
A
Division of Cardiothoracic and Vascular Surgery, Creighton University Medical Center, Omaha, Neb 68131, USA. akhoy@creighton.edu
Donayre
Carlos E
CE
Omari
Bassam O
BO
Kopchok
George E
GE
Walot
Irwin
I
White
Rodney A
RA
D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012189:Retrospective Studies; D015607:Stents; D025321:Surgery, Computer-Assisted; D015996:Survival Rate; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality