Outcomes of endovascular management for complicated chronic type B aortic dissection: effect of the extent of stent graft coverage and anatomic properties of aortic dissection.
OBJECTIVE
To assess the effect of the extent of stent graft coverage and anatomic properties of aortic dissection on the outcomes of thoracic endovascular aortic repair (TEVAR) for complicated chronic type B aortic dissection (CCBAD) in terms of survival, reintervention, and false lumen thrombosis.


METHODS
A retrospective analysis was performed of 71 patients who underwent TEVAR for CCBAD. Mean patient age was 54.7 years. Distal extent of stent graft coverage was categorized as short (≤ T7) or long (≥ T8) coverage. Indications of reintervention were categorized into three groups: proximal, alongside, and distal according to the anatomic relationship of the culprit lesion and the stent graft. Overall survival, reintervention-free survival, and extent of false lumen thrombosis were compared.


RESULTS
The technical success rate was 97.2%. The 1-year, 3-year, and 5-year overall survival rates were 97.1%, 88.9%, and 88.9%, and 1-year, 3-year, and 5-year reintervention-free survival rates were 80.7%, 73.8%, and 60.6%. There were no differences in overall survival, reintervention-free survival rates, and extent of false lumen thrombosis between the groups. In the short coverage group, distal reintervention was more frequent in patients with an abdominal aortic diameter ≥ 37 mm compared with patients with an abdominal aortic diameter < 37 mm (P = .005).


CONCLUSIONS
TEVAR was effective for CCBAD with a high technical success rate and low mortality. The extent of stent graft coverage did not make a difference in terms of survival and false lumen thrombosis. Reinterventions were more frequently performed in patients with a large baseline abdominal aortic diameter who were treated with short stent graft coverage, and so longer coverage is recommended in such patients.
Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Shinchon-dong, Seodaemun-gu, Seoul 120-752, Republic of Korea.
Myungsu
M
Lee
Do Yun
DY
Lee
Man Deuk
MD
Kim
Mu Sook
MS
Lee
Jong Yun
JY
Won
Sung Il
SI
Park
Young Nam
YN
Yoon
Sak
S
Lee
Donghoon
D
Choi
Young-Guk
YG
Ko
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality* / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality* / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data*; D002908:Chronic Disease; D015897:Comorbidity; D018572:Disease-Free Survival; D057510:Endovascular Procedures / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D015995:Prevalence; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data*; D015996:Survival Rate; D016896:Treatment Outcome
CCBAD; IQR; ROC; TEVAR; complicated chronic type B aortic dissection; interquartile range; receiver operating characteristics; thoracic endovascular aortic repair