Smoking history increases the risk of long-term mortality after thoracic endovascular aortic repair in patients with an uncomplicated type B dissection

Abstract OBJECTIVES To study the perioperative outcomes and long-term survival rates in patients undergoing thoracic endovascular aortic repair (TEVAR) for uncomplicated type B dissection. METHODS A total of 751 patients with uncomplicated type B dissection who underwent TEVAR at our centre between May 2001 and December 2013 were retrospectively reviewed. The mean age of all patients (619 males and 132 females) was 52.8 ± 10.9 years. The follow-up period ranged from 1 to 170 months (median 70 months). RESULTS Five patients died during the perioperative period (mortality rate 0.7%). Four patients (0.5%) developed retrograde type A dissection. Two patients (0.3%) developed paraplegia and 1 patient developed incomplete paralysis (0.1%). There were no postoperative cerebral infarctions. The 5- and 10-year survival rates were 96.5% [95% confidence interval (CI) 95.0–98.0%] and 83.0% (95% CI 77.9–88.4%), respectively. The 5- and 10-year reintervention rates were 4.6% (95% CI 3.0–6.2%) and 7.9% (95% CI 5.3–10.5%), respectively. CONCLUSIONS Although the application of TEVAR for patients with uncomplicated dissection is still under debate, many patients who have undergone TEVAR have benefitted substantially from the treatment. Our data showed that TEVAR had low mortality and complication rates both in the short- and long-term follow-up periods. TEVAR may be considered as a first choice for patients with uncomplicated type B dissection.

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Risk Factors Predicting for Perioperative and Long-Term Mortality in Acute and Subacute Thoracic Endovascular Aortic Repair Patients

Journal of Vascular Surgery ◽

10.1016/j.jvs.2021.06.192 ◽

2021 ◽

Vol 74 (3) ◽

pp. e125

Author(s):

Abhishek Rao ◽

Ambar Mehta ◽

Richard Schutzer ◽

Danielle Bajakian ◽

Nicholas Morrissey ◽

...

Keyword(s):

Risk Factors ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Aortic Repair ◽

Long Term Mortality

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Old Solutions for New Troubles in Complications after Thoracic Endovascular Aortic Repair

The Thoracic and Cardiovascular Surgeon Reports ◽

10.1055/s-0037-1606285 ◽

2017 ◽

Vol 06 (01) ◽

pp. e25-e28

Author(s):

German Fortunato ◽

Guillermo Stöger ◽

Ricardo Marenchino ◽

Vadim Kotowicz

Keyword(s):

Aortic Aneurysm ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Type B ◽

Ascending Aortic Aneurysm ◽

Endovascular Stent Graft ◽

Aortic Repair ◽

First Case ◽

Type B Dissection

Background The authors present two cases with type B aortic dissection initially treated by endovascular stent graft who developed aortic complications posttreatment and required surgical treatment. Case Description A 50-year-old woman and a 65-year-old man underwent endovascular treatment for thoracic aortic aneurysm associated with type B dissection and —both of them evolved with endoleak type 1. The first case was related to aortobronchial fistula, and the second one was associated with ascending aortic aneurysm. An extra-anatomical ascending aorta-supraceliac aorta bypass grafting was decided due to the persistent leak. Conclusion Surgery is an excellent choice for complex complications after thoracic endovascular aortic repair with previous failed attempts of endovascular resolution.

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The impact of thoracic endovascular aortic repair on long-term survival in type B aortic dissection

Annals of Translational Medicine ◽

10.21037/atm.2017.10.13 ◽

2017 ◽

pp. 496-496

Author(s):

Christos D. Karkos ◽

Ignacio Hernandez-Lahoz ◽

Nikolaos Asaloumidis ◽

Konstantinos O. Papazoglou

Keyword(s):

Aortic Dissection ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Type B ◽

Type B Aortic Dissection ◽

Term Survival ◽

Long Term Survival ◽

Aortic Repair ◽

The Impact

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Thoracic endovascular aortic repair (TEVAR) versus open versus medical management of type B dissection

Journal of Visualized Surgery ◽

10.21037/jovs.2017.12.19 ◽

2018 ◽

Vol 4 ◽

pp. 8-8 ◽

Cited By ~ 1

Author(s):

Erin Iannacone ◽

Leonard Girardi

Keyword(s):

Medical Management ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Type B ◽

Aortic Repair ◽

Type B Dissection ◽

Open Versus

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Thirty-day outcomes from the Society for Vascular Surgery Vascular Quality Initiative thoracic endovascular aortic repair for type B dissection project

Journal of Vascular Surgery ◽

10.1016/j.jvs.2018.06.203 ◽

2019 ◽

Vol 69 (3) ◽

pp. 680-691 ◽

Cited By ~ 8

Author(s):

Grace J. Wang ◽

Richard P. Cambria ◽

Joseph V. Lombardi ◽

Ali Azizzadeh ◽

Rodney A. White ◽

...

Keyword(s):

Vascular Surgery ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Type B ◽

Aortic Repair ◽

Type B Dissection

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Outcomes of Thoracic Endovascular Aneurysm Repair (TEVAR) in Patients With Connective Tissue Disorders

Vascular and Endovascular Surgery ◽

10.1177/1538574420945070 ◽

2020 ◽

Vol 54 (8) ◽

pp. 676-680

Author(s):

Khalil Qato ◽

Allan Conway ◽

Eileen Lu ◽

Nhan Nguyen Tran ◽

Gary Giangola ◽

...

Keyword(s):

Connective Tissue ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Acute Type ◽

Type B ◽

Connective Tissue Disorders ◽

Aortic Repair ◽

Type B Dissection ◽

Significant Difference

Objectives: Thoracic endovascular aortic repair (TEVAR) remains controversial in patients with connective tissue disorders given the concern for durability. We report on the largest series to date on outcomes of patients with thoracic aortic disease and connective tissue disorders treated with TEVAR. Methods: The Vascular Quality Initiative registry identified 12 207 patients treated with TEVAR from January 2010 to December 2018, including 102 with Marfans, Ehlers-Danlos, or Loey-Dietz syndrome. Outcomes were analyzed per the Society for Vascular Surgery reporting standards. Results: Median age was 50.6 years (interquartile range: 57.0-75.0), and 62 (60.7%) were male. Eighty-eight (86.3%) patients had Marfan, 9 (8.8%) had Ehlers-Danlos, and 5 (4.9%) had Loey-Dietz syndrome. Twenty-six (25.5%) patients were treated for degenerative aneurysmal disease and 76 (74.5%) patients for type B dissections (33 acute, 31 chronic). Most common indications for interventions in patients with type B dissection were pain (n = 41), aneurysmal degeneration (n = 16), and malperfusion (n = 8), with 3 patients who presented ruptured. There was no significant difference in perioperative complications between acute/chronic dissections and aneurysms ( P = .14). Percutaneous access was utilized in 61.7% of patients, with a 2.9% rate of arterial injury requiring reintervention. Follow-up data were available for 75 (73.3%) patients at a mean follow-up of 15.6 months. Overall mortality was 5.3%. There were 30 patients with follow-up endoleak data, and 8 (26.7%) endoleaks were identified. All endoleaks were in patients treated for acute type B dissection, and all resolved after a mean of 2.1 reinterventions. Three patients treated for acute Type B Aortic Dissection (TBAD) had retrograde dissections requiring intervention. Discussion: Thoracic endovascular aortic repair for patients with connective tissue disorders can be performed with low perioperative mortality, spinal cord ischemia, or Cerebrovascular Accident (CVA). On follow-up, acute type B aortic dissections represent a higher risk subgroup with increased rates of endoleak and retrograde dissection. Closer follow-up for these patients and early reintervention may be beneficial.

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