James Sampson MD, Marjan Mujib MD MPH, Mark A Patterson MD, Marc A Passman MD, Thomas C. Matthews, MD William D. Jordan MD
University of Alabama at Birmingham, Birmingham, AL.
OBJECTIVES: To review clinical outcomes of endovascular treatment of type B aortic dissection.
METHODS: All patients treated for type B aortic dissection between 2006-2011 were identified from a prospectively maintained registry. Health systems charts and medical correspondences were reviewed. Measured outcomes included resolution of the indication for intervention, additional procedures, and survival at 30 days and 1 year.
RESULTS: Fifty-five patients were treated with TEVAR for type B dissection (mean age, 61±14 years), 39 (71%) for acute dissections and 16 (29%) for chronic dissections. Indications for treatment were pain (21), malperfusion (13), aneurysm (6), uncontrolled hypertension (6), expansion (5), and rupture (4). Success, defined by relief of indication and freedom from death or re-intervention at 30 days, was achieved in 87% of patients. Twenty-six additional procedures were performed in 22 patients prior to, or at the time of TEVAR. These included debranching procedures (8), renal stenting (7), Iliac stenting (5), iliac exposure or conduit creation (2), mesenteric stenting (2), thrombectomy (1), and tube thoracostomy (1). Left subclavian artery coverage was required in 23 patients. Spinal ischemia occurred in 4 patients, and lumbar drainage performed in 2 patients. Three patients required reintervention during the study period. Survival was 93% at thirty-days and 78% at one year.
CONCLUSIONS: TEVAR is effective in the treatment of the complications of both acute and chronic type B aortic dissection. Additional procedures are frequently necessary, but early results indicate favorable outcomes, while re-intervention is rare.
AUTHOR DISCLOSURES: J. Sampson, Nothing to disclose; M. Mujib, Nothing to disclose; M. Patterson, Nothing to disclose; M. Passman, Nothing to disclose; T. Matthews, Nothing to disclose; W. Jordan, Nothing to disclose.
Posted April 2012