Predictors of outcome after endovascular repair for chronic type B dissection.
Eur J Vasc Endovasc Surg 2012;
43:386-91. [PMID:
22326695 DOI:
10.1016/j.ejvs.2012.01.016]
[Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 01/16/2012] [Indexed: 01/29/2023]
Abstract
OBJECTIVES
To assess the durability of endovascular repair (TEVAR) in chronic type B dissection (CD) and identify factors predictive of outcome.
DESIGN
Retrospective analysis of a prospective database.
MATERIALS
Patients undergoing TEVAR for CD at a tertiary referral centre 2000-2010.
METHODS
Analysis of pre-operative characteristics, operative outcome, false lumen thrombosis, aortic diameter and survival.
RESULTS
58 consecutive patients were included (49 elective, 9 urgent, mean age 66 years). Mean aortic diameter was 6.4 cm (Standard deviation SD 1.3 cm). Three patients died perioperatively (5%, 1 urgent, 2 elective). Complications included retrograde type A dissection (n = 3), paraplegia (1), and transient ischaemic attack (1). Estimated survival (Kaplan-Meier) was 89% (1-year) and 64% (3-years). Forty-seven patients had mid-term imaging follow-up at mean 38 months. Reintervention rate was 15% at 1-year and 29% at 3-years. Aortic diameter decreased in 24, was stable in 15 and increased in 8. Mid-term survival was higher in patients with aortic remodelling (reduction of aortic diameter >0.5 cm; 3-year 89%) than without (54%; Log Rank p = 0.005). Remodelling occurred with extensive false lumen thrombosis.
CONCLUSION
Satisfactory mid-term outcome after TEVAR for CD remains a challenge. Survival is associated with aortic remodelling, which is related to persistence of flow in the false lumen.
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