Study Evaluates TEVAR for Chronic Type B Aortic Dissections

May 15, 2018—A study of the outcomes of thoracic endovascular aortic repair (TEVAR) for chronic type B aortic dissection (TBAD) was published by Allan M. Conway, MBChB, et al in the Journal of Vascular Surgery (2018;67:1345–1352). The investigators assessed the effectiveness of TEVAR in the treatment of chronic TBAD using the Vascular Quality Initiative (VQI) database.

As summarized in Journal of Vascular Surgery, the VQI registry identified 4,713 patients treated with TEVAR from July 2010 to November 2015, including 125 repairs for chronic TBAD. TEVAR outcomes in this cohort were analyzed per the Society for Vascular Surgery's reporting standards for TEVAR.

The investigators reported that median age was 65 years (interquartile range [IQR], 56–72 years), and 85 (68%) patients were men. Median aneurysm diameter was 5.5 cm (IQR, 4.8–6.3 cm). On presentation, 62 (49.6%) patients were asymptomatic, 57 (45.6%) patients were symptomatic, and six (4.8%) patients presented with rupture. The median length of stay was 8 days (IQR, 4–11 days). Fluoroscopy time was 17.3 minutes (IQR, 10.5–25.6 minutes). The distal landing zone was aortic zone 4 in 27 (21.6%) patients and aortic zone 5 and distal in 98 (78.4%) patients.

The device was successfully delivered in 123 (98.4%) patients, and one (0.8%) patient required conversion to open repair. There was type Ia endoleak present in two (1.6%) patients, type Ib endoleak in two (1.6%) patients, and type II endoleak in two (1.6%) patients. Perioperative complications included stroke in one (0.8%) patient, respiratory complications in six (4.8%) patients, and spinal cord ischemia symptoms present at discharge in three (2.4%) patients.

In-hospital mortality occurred in three (2.4%) patients. Reintervention was required in four patients (two patients for false lumen perfusion and two for extension of the dissection [both 1.6%]).

Follow-up was available for 43 patients at a median time of 239 days (IQR, 38–377 days). Median change in sac diameter was -0.2 cm (IQR, -0.5 to 0.1 cm). Sac shrinkage of 0.5 cm was noted in 12 (27.9%) patients, with sac growth > 0.5 cm in four (9.3%) patients. The extent of stent graft coverage did not affect sac shrinkage (P = .65).

Patients with aneurysms ≥ 5.5 cm were more likely to demonstrate shrinkage as compared with those with aneurysms < 5.5 cm (-0.6 cm vs 0.0 cm; 95% confidence interval, 0.3–11.7; P = .04).

The investigators concluded that TEVAR for chronic TBAD may be performed with acceptable rates of morbidity and mortality. Changes in sac diameter in the midterm are promising. Long-term data are needed to determine whether this approach is durable, advised the investigators in the Journal of Vascular Surgery.