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DOI: 10.1055/s-0034-1367287
Effectiveness and limitation of endovascular repair for type B aortic dissection: perspective from long-term results
Introduction: Thoracic endovascular aortic repair (TEVAR) has developed to be the first line procedure to treat the complications of acute (within 14days from onset) type B aortic dissection, and recent studies suggest that it could even be embraced to replace the open surgery for managing uncomplicated chronic (after 14days form onset) dissection by preventing late aorta-specific mortality. Moreover, several studies suggested the impact of chronicity of the dissection to the long-term result, however its detailed analysis is still not yet described.
Patients and method: We retrospectively analyzed 251 thoracic endovascular aortic repairs for type B dissection performed between 1993 and 2013 in Osaka University. The patients (Male 199(79.3%), average 64.5 y.o) were treated both in acute phase (complicated or at risk for developing complication, n = 50) and in chronic phase (aortic diameter >50 mm or rapid enlargement, n = 201). The patients are divided into 4 groups by its treatment timing from symptom onset (Group A (n = 50): within 14days, B(n = 49): 15days to 3 month, C(n = 28): 3 month to1 year, D(n = 84): more than 1year), and early and long-term results were analyzed.
Result: The rate of operative mortality (A: 6.0%, B:0%, C:0%, D:1.2%) , stroke (A: 4.0%, B: 2.0%, C:0%, D:2.4%) were similar in all groups, and no spinal cord ischemia was observed. In long-term (average 40.8 month) follow up, the achievement of aortic remodeling at 6 month postoperatively was higher in group A and B (A:66.7%, B:71.4%, C:28.6%, D:42.3%, p = 0.0018). The aorta-specific survival (A: 92.7%, B:90.0%, C:71.8%, D:97.2% at 10year) and freedom from aortic event (A: 56.5% , B: 76.9%, C: 61.2%, D: 42.9% at 10year) were statistically similar in all groups, however the possibility to require re-intervention for persistent false lumen enlargement had a tendency to be high in more chronic group (A: 0%, B: 8.4%, C: 23.5%, D: 37.8% at 10year).
Conclusion: TEVAR was an effective procedure for type B dissection, however in more chronic dissection, the achievement of aortic remodeling could be difficult and re- entry intervention would be required. The undergoing prospective trial could provide important information to decide the treatment strategy for type B dissection.