Key result
In patients with type B aortic dissection undergoing TEVAR, preexisting descending thoracic aortic aneurysm was associated with a lower rate of complete thoracic false lumen thrombosis (45.2% vs 80.6%) and higher incidence of type Ia endoleak.
Why the study?
Few studies support guidelines for using TEVAR to address type B aortic dissection coexisting with descending thoracic aortic dissection and aneurysm.
Does the presence of descending thoracic aortic dissection and aneurysm (dTADA) worsen midterm outcomes in patients with type B aortic dissection undergoing TEVAR?
Cohort (n=129)
No
Does the presence of descending thoracic aortic dissection and aneurysm (dTADA) worsen midterm outcomes in patients with type B aortic dissection undergoing TEVAR?
In patients with type B aortic dissection undergoing TEVAR, the presence of a coexisting descending thoracic aortic aneurysm that fails to regress is associated with significantly higher mortality and reintervention risk.
Few studies support guidelines for the use of thoracic endovascular aortic repair (TEVAR) to address type B aortic dissection (TBAD) coexisting with descending thoracic aortic dissection and aneurysm (dTADA). This cohort study investigated midterm outcomes of TBAD with dTADA (dTADA group, n = 31) and without dTADA (non-dTADA group, n = 98) after TEVAR. Compared with the non-dTADA group, the dTADA group exhibited higher incidences of type Ia endoleak (29.0% vs. 3.1%, P < 0.001) and reintervention (16.1% vs. 5.1%, P = 0.045). The completely thrombosed rate of the thoracic false lumen was significantly lower in the dTADA group than in the non-dTADA group (45.2% vs. 80.6%, P < 0.001). Although the two groups exhibited similar mortality rates, TBAD coexisting with no regressive dTADA after TEVAR was an independent predictor of mortality (HR: 15.52, 95% CI: 1.614-149.233, P = 0.018). Moreover, the change percentages of false lumen retraction and true lumen re-expansion in the dTADA group were significantly inferior to those of the non-dTADA group at levels of 4th, 6th, 8th and 10th thoracic vertebra throughout follow-up. In conclusion, in the presence of preexisting dTADA, the failure of the dTADA to regress after TEVAR is associated with lower survival and a higher risk of reintervention.
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Wang et al. (2019) conducted a cohort in Type B aortic dissection (n=129). Preexisting descending thoracic aortic dissection and aneurysm (dTADA) vs. No preexisting dTADA was evaluated on Complete thrombosis of the thoracic false lumen (p=<0.001). In patients with type B aortic dissection undergoing TEVAR, preexisting descending thoracic aortic aneurysm was associated with a lower rate of complete thoracic false lumen thrombosis (45.2% vs 80.6%) and higher incidence of type Ia endoleak.
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