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Tevar In Uncomplicated Type B Aortic Dissection: A Retrospective Propensity-matched Evaluation Of Complications And Aneurysmal Degeneration
Ahmad Tabatabaeishoorijeh1, Maham Rahimi, MD PhD
2.
1Texas A&M School of Engineering Medicine (ENMED), Houston, TX, USA,
2Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA.
OBJECTIVES: TEVAR is widely used for type B aortic dissections (TBAD), but its efficacy in uncomplicated cases (UTBAD) is unclear. This study compares complications, such as aneurysmal degeneration and malperfusion, between medically managed UTBAD patients and those undergoing acute or subacute TEVAR.
METHODS: We retrospectively analyzed TEVAR patients with descending thoracic and thoracoabdominal aortic dissections using the TriNetX database. Patients were grouped into acute TEVAR (1-14 days), subacute TEVAR (14-90 days), and medical management. Those with prior malperfusion, aneurysm, or rupture were excluded. We compared mortality, rupture, aneurysmal degeneration, and malperfusion outcomes, with Kaplan-Meier analysis estimating 10-year freedom from aneurysmal degeneration in matched cohorts.
RESULTS: A total of 19,008 patients with uncomplicated thoracic and thoracoabdominal aortic dissections met the inclusion criteria: 914 (4.8%) managed with acute TEVAR, 207 (1.1%) with subacute TEVAR, and 17,887 (94.1%) with medical management. After propensity score matching, acute TEVAR showed significantly higher mortality at 1 month compared to medical management (6.7% vs 3.7%; P = .004). The acute TEVAR group also had higher rates of acute kidney injury at 1 month (2.8% vs 1.3%; P = .022). Thoracic aortic rupture risk was similar at 1 month but became significantly higher in acute TEVAR by 3 years (2.3% vs 1.1%; P = .046). Aneurysmal degeneration was significantly higher at 1 month for acute TEVAR compared to medical management (4.1% vs 1.1%; P < .001) (Table). Subacute TEVAR matched medical management in 5-year mortality, malperfusion, and rupture risk. However, aneurysmal degeneration risk became significantly higher by 6 months compared to medical management (10.1% vs 4.9%; P = .049). Acute and subacute TEVAR had significantly lower 10-year freedom from aneurysmal degeneration compared to medical management (82.4% vs 85.6%; P = .003 for acute; 60.7% vs 92.4%; P = .002 for subacute).
CONCLUSIONS: In UTBAD, acute TEVAR is linked to higher early mortality, acute kidney injury, and greater risks of aneurysmal degeneration and aortic rupture compared to medical management. Subacute TEVAR has similar mortality and malperfusion but increases the risk of aneurysmal degeneration by 6 months. These findings emphasize the need to carefully consider and time TEVAR for UTBAD.
Interval outcomes for 912 matched patients: Acute TEVAR (%) vs. medical management (%) (P value)| Outcome | 1 Month | 3 Month | 6 Month | 1 Year | 3 Year | 5 Year |
| Mortality | 6.7% vs 3.7% (.004) | 7.6% vs 4.8% (.012) | 8.7% vs 5.4% (.005) | 10.3% vs 6.8% (.007) | 13.6% vs 10.1% (.020) | 16.4% vs 12.5% (.016) |
| Acute Kidney Injury | 2.8% vs 1.3% (.022) | 3.5% vs 1.6% (.012) | 3.8% vs 2.2% (.040) | 4.3% vs 2.5% (.039) | 5.5% vs 4.3% (.232) | 6.1% vs 5.1% (.357) |
| Thoracic Aneurysmal Degeneration | 4.1% vs 1.1% (<.001) | 6.6% vs 1.6% (<.001) | 7.5% vs 1.9% (<.001) | 9.1% vs 3.1% (<.001) | 10.4% vs 5.7% (<.001) | 10.8% vs 6.6% (.001) |
| Thoracic Aortic Rupture | 1.1% vs 1.1% (1.0) | 1.7% vs 1.1% (.236) | 1.8% vs 1.1% (.174) | 2.1% vs 1.1% (.092) | 2.3% vs 1.1% (.046) | 2.3% vs 1.1% (.046) |
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