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J Thorac Cardiovasc Surg 2008;136:424-430
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Complicated acute type B aortic dissection: Midterm results of emergency endovascular stent–grafting

^a Department of Cardiothoracic Surgery and Division of Interventional Radiology, Stanford University School of Medicine, Stanford, Calif
^b Department of Cardiothoracic Surgery, Rennes University School of Medicine, Rennes, France

Received for publication March 19, 2006; revisions received December 31, 2007; accepted for publication January 5, 2008.

^_* Address for reprints: D. Craig Miller, MD, Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University Medical School, 300 Pasteur Drive, Stanford, CA 94305. (Email: dcm{at}stanford.edu).

Objective: This study assessed midterm results of emergency endovascular stent–grafting for patients with life-threatening complications of acute type B aortic dissection.

Methods: Between November 1996 and June 2004, 16 patients with complicated acute type B aortic dissections (mean age 57 years, range 16–88 years) underwent endovascular stent–grafting within 48 hours of presentation. Complications included contained rupture, hemothorax, refractory chest pain, and severe visceral or lower limb ischemia. Stent–graft types included custom-made first-generation endografts and second-generation commercial stent–grafts (Gore Excluder or TAG; W. L. Gore & Associates, Inc, Flagstaff, Ariz.). Follow-up was 100% complete, averaged 36 ± 36 months, and included postprocedural surveillance computed tomographic scans.

Results: Early mortality was 25% ± 11% (70% confidence limit), with no late deaths. No new neurologic complications occurred. According to the latest scan, 4 patients (25%) had complete thrombosis of the false lumen; the lumen was partially thrombosed in 6 patients (38%). Distal aortic diameter was increased in only 1 patient. Actuarial survival at 1 and 5 years was 73% ± 11%; freedom from treatment failure (including aortic rupture, device fault, reintervention, aortic death, or sudden, unexplained late death) was 67% ± 14% at 5 years.

Conclusion: With follow-up to 9 years, endovascular stent–grafting for patients with complicated acute type B aortic dissection conferred benefit. Consideration of emergency stent–grafting may improve the dismal outlook for these patients; future refinements in stent–graft design and technology and earlier diagnosis and intervention should be associated with improved results.

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