Introduction: Thoracic endovascular aortic repair (TEVAR) has become the preferred treatment modality of thoracic aortic pathologies. Since survival outcomes are influenced by disease acuity and pathology, we aim to compare mid-term outcomes of TEVAR in the management of thoracic aortic aneurysms (TAA) vs. Stanford type-B aortic dissections (TBAD). Methods: Patients undergoing TEVAR (2010-2019) in the Vascular Quality Initiative-Medicare-linked database were included in this analysis. Patients were divided into two groups: TAA and TBAD. Postoperative outcomes included 30-day mortality, stroke, myocardial infarction (MI), and spinal cord ischemia (SCI). Mid-term outcomes included 1 and 2-year all-cause mortality, reintervention and rupture. Results: Of the 2105 patients undergoing TEVAR in this analysis, 1,492 (70.9%) had TAA while 613 (29.1%) had TBAD. The TBAD group had a significantly lower 30-day mortality (aOR:0.67,95%Cl:0.46-0.98,P=0.037), lower 1-year mortality (aHR:0.72,95%CI:0.57-0.90, P=0.004) and also at 2 years (aHR:0.79,95%CI:0.65-0.95, P=0.013). Within 1 year, patients with TBAD had a significantly higher incidence of aneurysm related reintervention (18.8% vs. 12.9%, P=0.003). This finding persisted at 2 years (24.9% vs. 19.7%, P<0.001). There was no significant difference in rupture between groups at 2 years (4.1% vs. 3.4%, P=0.40). Conclusion: In this large multi-institutional study, patients undergoing TEVAR for TBAD had significantly lower postoperative mortality but a higher risk of reintervention at one and two years compared to patients with TAA. Additionally, both groups demonstrated a similar risk of rupture at both 1 and 2 years post-TEVAR. The rate of post-TEVAR rupture in both groups underscore the need for careful follow-up and reintervention as needed to maintain the integrity of the repair.
Dodo-Williams et al. (Sun,) studied this question.