Key result
TEVAR during the subacute phase of type B aortic dissection was associated with a lower major complication rate (14.4% vs 33.1% acute vs 27.3% chronic, p=0.002) and better overall survival (p=0.03).
Why the study?
To compare characteristics of acute, subacute, and chronic type B aortic dissection and their influence on long-term results of thoracic endovascular aortic repair.
Does the timing of thoracic endovascular aortic repair (acute, subacute, or chronic) affect long-term outcomes in patients with type B aortic dissection?
Cohort (n=314)
No
Does the timing of thoracic endovascular aortic repair (acute, subacute, or chronic) affect long-term outcomes in patients with type B aortic dissection?
p-value: p=0.002
TEVAR performed in the subacute phase of type B aortic dissection is associated with lower complication rates and better long-term survival compared to acute or chronic phases.
Subacute TEVAR was associated with lower mortality and reinterventions than acute or chronic; leaves open optimal timing pending prospective trials.
Purpose: To compare characteristics of acute, subacute, and chronic type B aortic dissection and their influence on long-term results of thoracic endovascular aortic repair (TEVAR). Materials and Methods: In a single-center, retrospective cohort study, 314 patients (median age 52 years; 244 men) with acute (n=165), subacute (n=115), or chronic (n=34) type B aortic dissection underwent TEVAR between January 2009 and December 2013. Patient demographics, risk factors, and imaging characteristics were compared among the groups. Univariable and multivariable Cox regression analyses were performed to identify any factors influencing survival. Results: The acute and subacute patients exhibited more complications at presentation than chronic patients. However, the chronic patients exhibited more aneurysmal dilatation (p<0.001) and true lumen collapse (p<0.001). Over a mean follow-up of 68.1±22.9 months (range 2–108), subacute patients showed a lower reintervention rate (3.6% vs 12.1% vs 12.1%, p=0.045), a lower major complication rate (14.4% vs 33.1% vs 27.3%, p=0.002), and better cumulative overall survival (p=0.03) than the acute and chronic groups, respectively. Furthermore, acute patients developed more stent-graft–induced distal erosion (p=0.017) and retrograde type A dissection (RTAD) (p=0.036), whereas chronic patients had less aortic remodeling in the stented segment (p<0.001), distal thoracic aorta (p<0.001), and abdominal aorta (p=0.047). Finally, multivariable analysis demonstrated age >52 years, visceral malperfusion, and RTAD as independent factors influencing overall survival; aneurysmal dilatation, rupture/impending rupture, and RTAD were independent factors influencing aorta-specific survival. Conclusion: Acute and subacute patients had increased risks of rupture and complications at presentation, whereas chronic patients had increased risks for aneurysmal dilatation. From a long-term perspective, the subacute phase might be an optimal time for TEVAR in cases of type B aortic dissection that do not need emergent interventions. The risk factors influencing survival should be identified, carefully managed, and possibly prevented.
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Li et al. (2020) conducted a cohort in Type B aortic dissection (n=314). Subacute phase type B aortic dissection vs. Acute and chronic phase type B aortic dissection was evaluated on Major complication rate (p=0.002). TEVAR during the subacute phase of type B aortic dissection was associated with a lower major complication rate (14.4% vs 33.1% acute vs 27.3% chronic, p=0.002) and better overall survival (p=0.03).
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