Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial.
BACKGROUND
Thoracic endovascular aortic repair (TEVAR) represents a therapeutic concept for type B aortic dissection. Long-term outcomes and morphology after TEVAR for uncomplicated dissection are unknown.


RESULTS
A total of 140 patients with stable type B aortic dissection previously randomized to optimal medical treatment and TEVAR (n=72) versus optimal medical treatment alone (n=68) were analyzed retrospectively for aorta-specific, all-cause outcomes, and disease progression using landmark statistical analysis of years 2 to 5 after index procedure. Cox regression was used to compare outcomes between groups; all analyses are based on intention to treat. The risk of all-cause mortality (11.1% versus 19.3%; P=0.13), aorta-specific mortality (6.9% versus 19.3%; P=0.04), and progression (27.0% versus 46.1%; P=0.04) after 5 years was lower with TEVAR than with optimal medical treatment alone. Landmark analysis suggested a benefit of TEVAR for all end points between 2 and 5 years; for example, for all-cause mortality (0% versus 16.9%; P=0.0003), aorta-specific mortality (0% versus 16.9%; P=0.0005), and for progression (4.1% versus 28.1%; P=0.004); Landmarking at 1 year and 1 month revealed consistent findings. Both improved survival and less progression of disease at 5 years after elective TEVAR were associated with stent graft induced false lumen thrombosis in 90.6% of cases (P<0.0001).


CONCLUSIONS
In this study of survivors of type B aortic dissection, TEVAR in addition to optimal medical treatment is associated with improved 5-year aorta-specific survival and delayed disease progression. In stable type B dissection with suitable anatomy, preemptive TEVAR should be considered to improve late outcome.


BACKGROUND
http://www.clinicaltrials.gov. Unique identifier: NCT01415804.
University of Rostock, Heart Center and Institute for Biostatistics, Rostock, Germany. christoph.nienaber@med.uni-rostock.de
Christoph A
CA
Nienaber
Stephan
S
Kische
Hervé
H
Rousseau
Holger
H
Eggebrecht
Tim C
TC
Rehders
Guenther
G
Kundt
Aenne
A
Glass
Dierk
D
Scheinert
Martin
M
Czerny
Tilo
T
Kleinfeldt
Burkhart
B
Zipfel
Louis
L
Labrousse
Rossella
R
Fattori
Hüseyin
H
Ince
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001013:Aorta, Thoracic / Q000473:pathology; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D015607:Stents
aortic dissection; aortic remodeling; prognosis; stent graft