Thoracic endovascular aortic repair for type B aortic dissection.
BACKGROUND
Thoracic endovascular aortic repair (TEVAR) has emerged as an acceptable off-label treatment modality for aortic dissection. We report our experience in endovascular treatment of this disease with an emphasis on defining the patterns of morbidity.


METHODS
We retrospectively reviewed all (n = 90) patients with thoracic aortic disease who received a TEVAR between February 2005 and December 2007. Aortic dissection was the indication in 23 (26%) patients (48% acute, 52% chronic; Stanford A 17%, Stanford B 83%). For the purposes of this report, we concentrated on the type B dissection (17 patients). Eighty-two percent of the patients were symptomatic on presentation, and 56% of cases were performed either urgently or emergently.


RESULTS
Technical success was achieved in 100% of cases, with an average operative time of 178 + or - 119 min. Forty-seven percent required a left subclavian bypass. Thirty-day mortality was 5.5% and morbidity was 12%. Postoperative complications included respiratory failure in 28% of cases, gastrointestinal symptoms in 11%, and cerebrovascular symptoms in 5.5%. No renal failure occurred. While cerebrospinal fluid drain was used in 35% of cases, transient spinal cord ischemia was observed in 5.5%. Average length of stay was 13 + or - 12 days; 63% of patients were discharged home, 12% required rehabilitation, and 25% were discharged to a skilled nursing facility. There was no association between outcome and mode of presentation or anatomic extent.


CONCLUSIONS
Aortic dissection remains a challenging clinical entity, and the advent of TEVAR has improved outcomes but still carries considerable morbidity, with distinct patterns between mode of presentation and anatomic extent.
Younes
Houssam K
HK
Department of Cardiovascular Surgery, Methodist DeBakey Heart and Vascular Center and The Methodist Hospital Research Institute, The Methodist Hospital, Houston, 6550 Fannin Street, Smith TowereSuite 1401, Houston, TX 77030, USA.
Harris
Patricia W
PW
Bismuth
Jean
J
Charlton-Ouw
Kristofer
K
Peden
Eric K
EK
Lumsden
Alan B
AB
Davies
Mark G
MG
D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D007902:Length of Stay; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional