Short Term Outcomes of TEVAR for Chronic Type B Aortic Dissections with Aneurysm
Allan M. Conway, MBChb (Hons), MRCS (Eng), Khalil Qato, MD, Laurie R. Mondry, BSN, Guillaume J. Stoffels, MS, MA, Gary Giangola, MD, Alfio Carroccio, MD.
Lenox Hill Hospital, New York, NY, USA.
OBJECTIVES: Open surgical repair remains the gold standard treatment for chronic type B aortic dissections (CTBAD) with aneurysm. Thoracic endovascular aortic repair (TEVAR) has gained popularity for the treatment of thoracic aortic pathologies, including CTBAD. We assessed the effectiveness of TEVAR in the treatment of CTBAD using the Vascular Quality Initiative (VQI) database. METHODS: The VQI registry identified 4713 patients treated with TEVAR from July 2010 to November 2015, including 125 repairs for CTBAD with aneurysm. We analyzed outcomes in this cohort as per the Society for Vascular Surgery reporting standards for TEVAR. RESULTS: Median age was 65.0 years (interquartile range [IQR], 56.0-72.0 years). Eighty-five (68%) were male. Median aneurysm diameter was 5.5cm (IQR, 4.8-6.3cm). Sixty-two (50%) patients were asymptomatic on presentation, 57 (46%) symptomatic and 6 (5%) presented with rupture. Median length of stay was 8.0 days (IQR, 4.0-11.0 days). Fluoroscopy time was 17.3 minutes (IQR, 10.5-25.6 minutes). The distal landing zone was Aortic Zone 4 in 27 (22%), and Aortic Zone 5 and distal in 98 (78%) patients. Successful device delivery occurred in 123 (98%) patients. Conversion to open repair occurred in one (1%) patient. A Type IA endoleak was present in two (2%), Type IB endoleak in two (2%) and Type II endoleak in two (2%) patients. Perioperative complications included stroke in two (2%), respiratory complications in six (5%), and spinal cord ischemic symptoms present at discharge in three (2%) patients. In-hospital mortality occurred in three (2%) patients. Re-intervention was required in two (2%) patients for false lumen perfusion, and two (2%) patients for extension of the dissection. Follow-up was available for 43 patients at a median time of 239 days (IQR, 38-377 days). Median change in sac diameter was -0.2cm (IQR, -0.5 to 0.1cm). Sac shrinkage of >5mm was noted in 12 (28%), with sac growth >5mm in four (9%) patients. Extent of stent graft coverage did not affect sac shrinkage (p=0.65). Aneurysms ≥ 5.5cm compared to <5.5cm were more likely to demonstrate shrinkage (-0.6cm vs. 0.0cm, 95% CI for diff. in means: 0.03 to 1.17, p=0.04). CONCLUSIONS: TEVAR for CTBAD may be performed with acceptable rates of morbidity and mortality. Sac diameter changes in the short term are promising. Long-term data is needed to determine whether this approach is durable.
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