Predictors of outcome after endovascular repair for chronic type B dissection.
OBJECTIVE
To assess the durability of endovascular repair (TEVAR) in chronic type B dissection (CD) and identify factors predictive of outcome.


METHODS
Retrospective analysis of a prospective database.


METHODS
Patients undergoing TEVAR for CD at a tertiary referral centre 2000-2010.


METHODS
Analysis of pre-operative characteristics, operative outcome, false lumen thrombosis, aortic diameter and survival.


RESULTS
58 consecutive patients were included (49 elective, 9 urgent, mean age 66 years). Mean aortic diameter was 6.4 cm (Standard deviation SD 1.3 cm). Three patients died perioperatively (5%, 1 urgent, 2 elective). Complications included retrograde type A dissection (n = 3), paraplegia (1), and transient ischaemic attack (1). Estimated survival (Kaplan-Meier) was 89% (1-year) and 64% (3-years). Forty-seven patients had mid-term imaging follow-up at mean 38 months. Reintervention rate was 15% at 1-year and 29% at 3-years. Aortic diameter decreased in 24, was stable in 15 and increased in 8. Mid-term survival was higher in patients with aortic remodelling (reduction of aortic diameter >0.5 cm; 3-year 89%) than without (54%; Log Rank p = 0.005). Remodelling occurred with extensive false lumen thrombosis.


CONCLUSIONS
Satisfactory mid-term outcome after TEVAR for CD remains a challenge. Survival is associated with aortic remodelling, which is related to persistence of flow in the false lumen.
Department of Vascular Surgery, Guy's and St Thomas NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK. kevin.mani@surgsci.uu.se
K
K
Mani
R E
RE
Clough
O T A
OT
Lyons
R E
RE
Bell
T W
TW
Carrell
H A
HA
Zayed
M
M
Waltham
P R
PR
Taylor
D000368:Aged; D000784:Aortic Dissection / Q000145:classification / Q000601:surgery*; D001014:Aortic Aneurysm / Q000145:classification / Q000601:surgery*; D002908:Chronic Disease; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors