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J Thorac Cardiovasc Surg 2009;138:625-631
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Midterm results of endovascular treatment of complicated acute type B aortic dissection

^a Division of Cardiothoracic and Vascular Surgery, Creighton University Medical Center, Omaha, Neb
^b Division of Vascular and Endovascular Surgery, Harbor–UCLA Medical Center, Torrance, Calif
^c Division of Cardiothoracic Surgery, Harbor–UCLA Medical Center, Torrance, Calif
^d Division of Interventional Radiology, Harbor–UCLA Medical Center, Torrance, Calif

Received for publication June 26, 2008; revisions received April 4, 2009; accepted for publication April 22, 2009.

^_* Address for reprints: Ali Khoynezhad, MD, PhD, Associate Professor of Cardiothoracic and Vascular Surgery, Director of Aortic and Endovascular Surgery, Creighton University Medical Center, 601 N 30th St, Suite 3700, Omaha, NE 68131. (Email: akhoy{at}creighton.edu).

Objectives: The operative mortality and morbidity of patients with complicated acute type B aortic dissection remain high. The endovascular approach has been proposed as a potential alternative. The purpose of this study is to review the contemporary outcome of patients undergoing endovascular treatment for complicated acute type B aortic dissection.

Methods: A retrospective analysis of 28 patients undergoing endovascular interventions for acute type B aortic dissection was performed. Kaplan–Meier survival analysis was used for statistical computation.

Results: Indications for emergency endografting were rupture in 4 (14%) patients, severe lower body malperfusion in 8 (29%) patients, visceral/renal malperfusion in 7 (25%) patients, persistent chest pain despite proper anti-impulsive therapy in 5 (18%) patients, uncontrollable hypertension in 1 (4%) patient, and acute dilatation of false lumen with impending rupture in 3 (11%) patients. Three (11%) patients died early. Three patients died during follow-up of non–aorta-related causes. Overall survival was 82% and 78% at 1 and 5 years' follow-up, respectively. The aorta-related mortality was 10% for the entire follow-up period. Complete thrombosis of the false lumen in the thoracic aorta was achieved in 22 (85%) members of the surviving cohort, and partial thrombosis was achieved in the remainder. The rate of treatment failure according to Stanford criteria was 18% at 5 years. Mean follow-up was 36 months, and follow-up was complete in 28 (100%) patients.

Conclusions: Thoracic aortic endografting for complicated acute type B aortic dissection can be performed with a relatively low postoperative morbidity and mortality in experienced hands. The endovascular approach to life-threatening complications of acute type B aortic dissection appears to have a favorable outcome in midterm follow-up.