Is endovascular repair a durable option for chronic type B aortic dissection?

Abstract

Purposes: Endovascular repair (TEVAR) has gained popularity in treating chronic type B aortic dissection by depressurizing the false lumen and preventing rupture. However, the outcome of the procedures could be affected by the chronicity of the dissection flap and the presence of multiple fenestration sites. This study is to investigate the short- and mid-term outcomes of TEVAR in chronic type B aortic dissection. Methodology: From 2004 to 2011, a total of 67 consecutive patients with chronic type B aortic dissection were treated by TEVAR. Their preoperative characteristics, operative outcomes, and survivals were analyzed. Results: The mean time interval between dissection and the first operation was 39.1 + 7.7 months. The mean aortic diameter was 5.3 + 0.18cm. Nineteen patients required hybrid procedure to extend the proximal landing zone. Complications included retrograde type A dissection (n=2) and paraplegia (n=1). The 30-day mortality rate was 0.7%. Fifty-five patients had mid-term follow-up of which 11 patients had distal tear after 41.6 + 3.6 months. The aortic diameter increased in 17 patients, remained static in 25, and decreased in 13. Aortic dilatation after TEVAR is associated with a lower survival rate (81.4% at 3 years). The 1-, 3- and 5-year estimated overall survival rates were 91%, 85.9%, and 78.7%, respectively. Only one patient died of aortic rupture after procedure. The re-intervention rate at 1 year and 3 years were 4.4% and 30.1%, respectively. Conclusion: TEVAR carries low peri-operative mortality and morbidity, however its long-term durability is challenged by distal tear and aortic dilatation.