Midterm results of endovascular treatment of complicated acute type B aortic dissection

Khoynezhad, Ali; Donayre, Carlos E.; Omari, Bassam O.; Kopchok, George E.; Walot, Irwin; White, Rodney A.

doi:10.1016/j.jtcvs.2009.04.044

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 3 , Pages 625-631, September 2009

Midterm results of endovascular treatment of complicated acute type B aortic dissection

Ali Khoynezhad, MD
- Division of Cardiothoracic and Vascular Surgery, Creighton University Medical Center, Omaha, Neb
- Address for reprints: Ali Khoynezhad, MD, PhD, Associate Professor of Cardiothoracic and Vascular Surgery, Director of Aortic and Endovascular Surgery, Creighton University Medical Center, 601 N 30th St, Suite 3700, Omaha, NE 68131.
Carlos E. Donayre, MD
- Division of Vascular and Endovascular Surgery, Harbor–UCLA Medical Center, Torrance, Calif
Bassam O. Omari, MD
- Division of Cardiothoracic Surgery, Harbor–UCLA Medical Center, Torrance, Calif
George E. Kopchok, BS
- Division of Vascular and Endovascular Surgery, Harbor–UCLA Medical Center, Torrance, Calif
Irwin Walot, MD
- Division of Interventional Radiology, Harbor–UCLA Medical Center, Torrance, Calif
Rodney A. White, MD
- Division of Vascular and Endovascular Surgery, Harbor–UCLA Medical Center, Torrance, Calif

Received 26 June 2008; received in revised form 4 April 2009; accepted 22 April 2009.

Objectives

The operative mortality and morbidity of patients with complicated acute type B aortic dissection remain high. The endovascular approach has been proposed as a potential alternative. The purpose of this study is to review the contemporary outcome of patients undergoing endovascular treatment for complicated acute type B aortic dissection.

Methods

A retrospective analysis of 28 patients undergoing endovascular interventions for acute type B aortic dissection was performed. Kaplan–Meier survival analysis was used for statistical computation.

Results

Indications for emergency endografting were rupture in 4 (14%) patients, severe lower body malperfusion in 8 (29%) patients, visceral/renal malperfusion in 7 (25%) patients, persistent chest pain despite proper anti-impulsive therapy in 5 (18%) patients, uncontrollable hypertension in 1 (4%) patient, and acute dilatation of false lumen with impending rupture in 3 (11%) patients. Three (11%) patients died early. Three patients died during follow-up of non–aorta-related causes. Overall survival was 82% and 78% at 1 and 5 years' follow-up, respectively. The aorta-related mortality was 10% for the entire follow-up period. Complete thrombosis of the false lumen in the thoracic aorta was achieved in 22 (85%) members of the surviving cohort, and partial thrombosis was achieved in the remainder. The rate of treatment failure according to Stanford criteria was 18% at 5 years. Mean follow-up was 36 months, and follow-up was complete in 28 (100%) patients.

Conclusions

Thoracic aortic endografting for complicated acute type B aortic dissection can be performed with a relatively low postoperative morbidity and mortality in experienced hands. The endovascular approach to life-threatening complications of acute type B aortic dissection appears to have a favorable outcome in midterm follow-up.

Abbreviations and Acronyms: CT, computed tomographic, TEVAR, thoracic endovascular aortic repair

CTSNet classification: 18, 26, 28, 33