Key success factors for thoracic endovascular aortic repair for non-acute Stanford type B aortic dissection

Abstract

Objectives: We aimed to determine the key factors associated with successful early and late outcomes after thoracic endovascular aortic repair (TEVAR) for non-acute Stanford type B aortic dissection at our institution.

Methods: Inpatient and outpatient records were retrospectively reviewed. Patients operated on within 14 days after the onset of acute aortic dissection and those with rupture or malperfusion were excluded.

Results: Forty-five patients (mean age, 55.5 ± 13.1 years; 23-79 years) underwent 53 TEVAR operations for non-acute Stanford type B aortic dissection between 1998 and 2012. Thirty-four patients had a patent false lumen and 19 had an ulcer-like projection (ULP). No early mortality was observed. At late follow-up (7.5 ± 3.9 years) of the 45 patients, survival after the initial TEVAR was 100, 86 and 63%; freedom from aortic reintervention was 87, 73 and 59%; and freedom from open aortic surgery was 89, 84 and 73%, at 1, 5 and 10 years, respectively. Of 15 late deaths, 2 were due to aortic rupture and 2 were operative deaths associated with aortic surgery. Of the 34 patients with patent false lumens before TEVAR, 25 had their descending false lumens thrombosed; of these 25, 16 had remodelling of the descending aorta; and of these 16, 4 had complete obliteration of the false lumen of the entire aorta. By bivariate analysis, the site of the primary entry and age were significantly associated with thrombosis of the descending false lumen, maximum aortic diameter was associated with remodelling of the descending aorta, and absence of abdominal branches arising from the false lumen was associated with complete obliteration of the false lumen of the entire aorta.

Conclusions: The early results of TEVAR for non-acute Stanford type B aortic dissection were favourable. However, for cases with patent false lumens, complete obliteration of the false lumen of the entire aorta was difficult to achieve. Absence of the primary entry at the outer curvature of the distal aortic arch, younger age, small aortic diameter and absence of the abdominal aortic branches arising from the false lumen were the key success factors.

Keywords: Aortic remodelling; Chronic type B aortic dissection; Thoracic endovascular aortic repair.