Early and Long-Term Effect of Thoracic Endovascular Aortic Repair for Stanford B Aortic Dissection

Abstract Background Proteinuria is a marker of poor outcomes in several diseases; however, few studies have been conducted to explore the prognostic value of proteinuria, assessed by urine dipstick test, for clinical outcomes in patients with type B acute aortic dissection (TBAD) undergoing thoracic endovascular aortic repair (TEVAR). Methods Consecutive patients with TBAD undergoing TEVAR were enrolled from January 2010 to July 2015. Proteinuria was defined as trace or higher, according to the results of urine dipstick testing. Associations among proteinuria and adverse events were evaluated. Results In total, 671 patients with a mean age of 44±15 years were included in the analysis. Proteinuria was detected in 281 patients (41.9%) before TEVAR. Multivariate logistic regression analysis showed that C-reactive protein and impaired renal function were independent predictors for proteinuria. During hospitalization, 21 patients died. In-hospital mortality was higher in patients with proteinuria (1.5% vs. 5.3%, p=0.005). After a median 3.4 years follow up, the post-TEVAR death rate was 10.4% (85 patients were lost to follow-up). The long-term cumulative mortality was significantly higher in patients with proteinuria (17.2% vs. 8.2%, log-rank=11.36, p=0.001). Multivariate Cox survival modeling indicated that proteinuria was significantly associated with long-term death, after adjustment for potential confounding risk factors (HR=1.92, p=0.012). Conclusions Pre-TEVAR proteinuria was identified as a prognostic marker in patients with TBAD and has potential for application as a convenient and simple risk assessment method before TEVAR.

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Favorable Impact of Thoracic Endovascular Aortic Repair on Long-Term Survival in Patients With Acute Uncomplicated Type B Aortic Dissection

Journal of Vascular Surgery ◽

10.1016/j.jvs.2017.07.080 ◽

2017 ◽

Vol 66 (4) ◽

pp. e90

Author(s):

James C. Iannuzzi ◽

Sahael M. Stapleton ◽

Yanik J. Bababekov ◽

David C. Chang ◽

Robert T. Lancaster ◽

...

Keyword(s):

Aortic Dissection ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Type B ◽

Type B Aortic Dissection ◽

Term Survival ◽

Long Term Survival ◽

Aortic Repair

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What is the optimal timing for Thoracic Endovascular Aortic Repair in uncomplicated Type B aortic dissection? Facts, fallacies and the future

10.22541/au.163656336.60945236/v1 ◽

2021 ◽

Author(s):

Matti Jubouri ◽

Mohamad Bashir ◽

Sven Zhen Cian Patrick Tan ◽

Damian Bailey ◽

Richard Anderson ◽

...

Keyword(s):

Aortic Dissection ◽

Gold Standard ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Therapeutic Window ◽

Survival Outcomes ◽

Type B ◽

Type B Aortic Dissection ◽

Aortic Repair

Background: Uncomplicated Stanford Type B aortic dissection (un-TBAD) is characterised by a tear in the aorta distal to the left subclavian artery without ascending aorta and arch involvement. Optimised cardiovascular control (blood pressure and heart rate) is the current gold standard treatment according to current international guidelines. However, emerging evidence indicates that Thoracic Endovascular Aortic Repair (TEVAR) is both safe and effective in the treatment of un-TBAD with improved long-term survival outcomes in combination with optimal medical therapy (OMT) relative to OMT alone. However, the optimal timeframe for intervention is not entirely clarified. Aims: This review critically addresses current state-of-the-art comparing TEVAR with OMT and corresponding clinical outcomes for un-TBAD based on timing of intervention. Methods: We carried out a comprehensive literature search on multiple electronic databases including PUBMED and Scopus in order to collate all research evidence on timing of TEVAR in uncomplicated Type B aortic dissection. Results: TEVAR has proven to be a safe and effective treatment for un-TBAD in combination with OMT through comparable survival outcomes, improved aortic remodelling, and relatively low periprocedural added risks. Though the timing of intervention remains controversial, it is becoming clear that performing TEVAR during the subacute phase of un-TBAD yields better outcomes compared to earlier and delayed (>90 days) intervention. Conclusions: Further research is required into both short and long-term outcomes of TEVAR in addition to its optimal therapeutic window for un-TBAD. With stronger evidence, TEVAR is likely to be adopted as the gold-standard intervention for un-TBAD with definitive timeframe guidelines.

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