title: Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial.
abstract: OBJECTIVE
  Uncomplicated acute type B aortic dissection (AD) treated conservatively has a 10% 30-day mortality and up to 25% need intervention within 4 years. In complicated AD, stent grafts have been encouraging. The aim of the present prospective randomised trial was to compare best medical treatment (BMT) with BMT and Gore TAG stent graft in patients with uncomplicated AD. The primary endpoint was a combination of incomplete/no false lumen thrombosis, aortic dilatation, or aortic rupture at 1 year.
  
  
  METHODS
  The AD history had to be less than 14 days, and exclusion criteria were rupture, impending rupture, malperfusion. Of the 61 patients randomised, 80% were DeBakey type IIIB.
  
  
  RESULTS
  Thirty-one patients were randomised to the BMT group and 30 to the BMT+TAG group. Mean age was 63 years for both groups. The left subclavian artery was completely covered in 47% and in part in 17% of the cases. During the first 30 days, no deaths occurred in either group, but there were three crossovers from the BMT to the BMT+TAG group, all due to progression of disease within 1 week. There were two withdrawals from the BMT+TAG group. At the 1-year follow up there had been another two failures in the BMT group: one malperfusion and one aneurysm formation (p = .056 for all). One death occurred in the BMT+TAG group. For the overall endpoint BMT+TAG was significantly different from BMT only (p < .001). Incomplete false lumen thrombosis, was found in 13 (43%) of the TAG+BMT group and 30 (97%) of the BMT group (p < .001). The false lumen reduced in size in the BMT+TAG group (p < .001) whereas in the BMT group it increased. The true lumen increased in the BMT+TAG (p < .001) whereas in the BMT group it remained unchanged. The overall transverse diameter was the same at the beginning and after 1 year in the BMT group (42.1 mm), but in the BMT+TAG it decreased (38.8 mm; p = .062).
  
  
  CONCLUSIONS
  Uncomplicated AD can be safely treated with the Gore TAG device. Remodelling with thrombosis of the false lumen and reduction of its diameter is induced by the stent graft, but long term results are needed.
authors: Department of Vascular and Endovascular Surgery, University Clinics, University of Cologne, Cologne, Germany. Electronic address: jan.brunkwall@uk-koeln.de.
authors: J
authors: J
authors: Brunkwall
authors: Section of Vascular Surgery, Department of Surgery, University of Regensburg, Department of Vascular Surgery, Klinikum Nuernberg, Nuremberg, Germany.
authors: P
authors: P
authors: Kasprzak
authors: Department of Cardiovasc Surgery Antonius Hospital, Nieuwegein, The Netherlands.
authors: E
authors: E
authors: Verhoeven
authors: Department of Vascular Surgery, St Guys Hospital, London, UK.
authors: R
authors: R
authors: Heijmen
authors: Department of Vascular Surgery, St Guys Hospital, London, UK.
authors: P
authors: P
authors: Taylor
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authors: Alric
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authors: Canaud
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authors: Janotta
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authors: Raithel
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authors: Malina
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authors: Resch
authors: H-H
authors: HH
authors: Eckstein
authors: S
authors: S
authors: Ockert
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authors: Larzon
authors: F
authors: F
authors: Carlsson
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authors: Schumacher
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authors: S
authors: Classen
authors: P
authors: P
authors: Schaub
authors: J
authors: J
authors: Lammer
authors: L
authors: L
authors: Lönn
authors: R E
authors: RE
authors: Clough
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authors: V
authors: Rampoldi
authors: S
authors: S
authors: Trimarchi
authors: J-N
authors: JN
authors: Fabiani
authors: D
authors: D
authors: Böckler
authors: D
authors: D
authors: Kotelis
authors: D
authors: D
authors: Böckler
authors: D
authors: D
authors: Kotelis
authors: H
authors: H
authors: von Tenng-Kobligk
authors: N
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authors: Mangialardi
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authors: Ronchey
authors: G
authors: G
authors: Dialetto
authors: V
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authors: Matoussevitch
mesh_terms: D000208:Acute Disease; D000784:Aortic Dissection / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: Acute type B dissection; Remodelling; Stent graft; Thrombosis; Uncomplicated