Propensity Score-Matched Analysis of Open Surgical and Endovascular Repair for Type B Aortic Dissection

Objective. To identify national outcomes of thoracic endovascular aortic repair (TEVAR) for type B aortic dissections (TBADs).Methods. The Nationwide Inpatient Sample database was examined from 2005 to 2008 using ICD-9 codes to identify patients with TBAD who underwent TEVAR or open surgical repair. We constructed separate propensity models for emergently and electively admitted patients and calculated mortality and complication rates for propensity score-matched cohorts of TEVAR and open repair patients.Results. In-hospital mortality was significantly higher following open repair than TEVAR (17.5% versus 10.8%,P= .045) in emergently admitted TBAD. There was no in-hospital mortality difference between open repair and TEVAR (5.6% versus 3.3%,P= .464) for elective admissions. Hospitals performing thirty or more TEVAR procedures annually had lower mortality for emergent TBAD than hospitals with fewer than thirty procedures.Conclusions. TEVAR produces better in-hospital outcomes in emergent TBAD than open repair, but further longitudinal analysis is required.

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Laser Fenestration for Treatment of a Complicated Chronic Type B Aortic Dissection

Vascular and Endovascular Surgery ◽

10.1177/1538574417749401 ◽

2018 ◽

Vol 52 (3) ◽

pp. 212-217 ◽

Cited By ~ 1

Author(s):

Tara Talaie ◽

Christopher Werter ◽

Charles Drucker ◽

Brittany O. Aicher ◽

Robert Crawford ◽

...

Keyword(s):

Aortic Dissection ◽

Open Repair ◽

False Lumen ◽

Thoracic Endovascular Aortic Repair ◽

Challenging Problem ◽

Type B ◽

Type B Aortic Dissection ◽

Endovascular Techniques ◽

Chronic Type ◽

Aortic Dissections

We report a case of a complex chronic type B aortic dissection treated by thoracic endovascular aortic repair and laser fenestration of the false septum to preserve flow to branch vessels originating from both the true and false lumen. Dissections complicated by thoracoabdominal aneurysmal degeneration with critical organs being perfused by branches arising from both true and false lumens are rare and leave limited options for repair. Despite advancements in endovascular techniques, fenestration remains one of the only means of preserving flow to both the true and false lumens and thus was necessary in the management of our patient. This novel procedure allows complex aortic dissections to be addressed endovascularly, which increases the flexibility and management of this challenging problem that previously required an open repair with significant morbidity.

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Open repair of chronic type B aortic dissection

Journal of Visualized Surgery ◽

10.21037/jovs-20-99 ◽

2021 ◽

Vol 0 ◽

pp. 0-0

Author(s):

Joel S. Corvera ◽

Philip J. Hess Jr ◽

John W. Fehrenbacher

Keyword(s):

Aortic Dissection ◽

Open Repair ◽

Type B ◽

Type B Aortic Dissection ◽

Chronic Type

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Effect of Dihydropyridine Calcium-Channel Blocker on Adverse Aortic Events After Thoracic Endovascular Aortic Repair for Type B Aortic Dissection

10.21203/rs.3.rs-877422/v1 ◽

2021 ◽

Author(s):

Fan Yang ◽

Lyufan Chen ◽

Jitao Liu ◽

Songyuan Luo ◽

Caiyun He ◽

...

Keyword(s):

Propensity Score ◽

Aortic Dissection ◽

Calcium Channel ◽

Propensity Score Matching ◽

Calcium Channel Blocker ◽

Channel Blocker ◽

Thoracic Endovascular Aortic Repair ◽

Type B ◽

Type B Aortic Dissection ◽

Dihydropyridine Calcium Channel Blocker

Abstract Objectives: This study aimed to evaluate the effect of dihydropyridine calcium-channel blocker (CCB) on adverse aortic events (AAE) in patients undergoing thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). Methods: A retrospective study was conducted on patients undergoing TEVAR of TBAD from January 2010 to December 2017 in our center. Patients were divided into CCB group and non-CCB group according to the postoperative dihydropyridine CCB use. AAE including aorta-relative mortality and reintervention, were compared between these two groups. Propensity score matching analysis was performed to avoid the potential effect of known confounders.Results: Before matching, the study cohort comprised 548 patients, including 435 (79.4%) and 113 (20.6%) patients in the CCB and non-CCB groups, respectively. After matching, 101 patients in each group were eligible for the analysis. In the unmatched cohort, AAE occurred in 52 (12.0%) and 29 (25.7%) patients in the CCB and non-CCB groups, respectively (P < 0.001). In the matched cohort, AAE occurred in 8 (7.9%) and 22 (21.8%) patients in the CCB and non-CCB groups, respectively (P = 0.013). Log-rank test analysis revealed that the levels of freedom from AAE were significantly different between the 2 groups in both the unmatched and matched cohorts (P < 0.001 and P = 0.007, respectively). Multivariable analysis showed that CCB use (hazard ratio 0.50, 95% confidence interval 0.32–0.80; P = 0.003) was associated with a lower AAE rate after adjustment for other variables, and was minimally changed after the propensity score matching (HR 0.34, 95% CI 0.15–0.75; P = 0.008).Conclusions: Postoperative dihydropyridine CCB use is protective in patients undergoing TEVAR for acute and sub-acute TBAD.

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Computed tomography findings and in-hospital mortality in patients with rupture of type B aortic dissection

Acta Radiologica ◽

10.1177/0284185119852730 ◽

2019 ◽

Vol 61 (1) ◽

pp. 136-144

Author(s):

Tetsuhiro Otsuka ◽

Eijun Sueyoshi ◽

Yutaro Tasaki ◽

Masataka Uetani

Keyword(s):

Computed Tomography ◽

Aortic Dissection ◽

Hospital Mortality ◽

Female Gender ◽

Pleural Space ◽

Hazard Ratio ◽

Maximum Diameter ◽

Type B ◽

Type B Aortic Dissection ◽

Ct Findings

Background The relationships between the computed tomography (CT) findings and outcomes of patients with ruptured type B aortic dissection have not been clarified. Purpose To evaluate the initial CT findings of patients with ruptured type B aortic dissection and investigate the relationships between the initial CT findings and in-hospital mortality. Material and Methods This study was approved by the institutional review board. Thirty-three patients were diagnosed with ruptured Stanford type B aortic dissection at our hospital between 2007 and 2016 (21 men, 12 women; mean age = 76.1±10.7 years). We retrospectively evaluated the initial CT findings of ruptured type B aortic dissection and the relationships between clinical factors and in-hospital mortality using logistic regression analysis. Results Type B aortic dissections ruptured in the acute and chronic phases in 23 and 10 patients, respectively. The initial CT images showed various findings, including an open false lumen (58%), arch involvement (88%), hematomas in the pleural space (55%), hematomas in the pericardial space (18%), and the extravasation of vascular contrast material (12%). The mean maximum diameter of the affected aorta was 49.5 ± 16.1 mm. Among the 33 patients, 14 died at hospital. Female gender (hazard ratio = 10.284; 95% confidence interval [CI] = 1.61–65.54; P = 0.0136) and the presence of a hematoma in the pleural space (hazard ratio = 6.803; 95% CI = 1.07–43.24; P = 0.0421) were found to be predictors of in-hospital mortality. Conclusion Female gender and the presence of a hematoma in the pleural space are significant predictors of in-hospital mortality in patients with ruptured type B aortic dissection.

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Cost-effectiveness of endovascular versus open repair of acute complicated type B aortic dissections

Journal of Vascular Surgery ◽

10.1016/j.jvs.2013.11.086 ◽

2014 ◽

Vol 59 (5) ◽

pp. 1247-1255 ◽

Cited By ~ 12

Author(s):

Thomas Luebke ◽

Jan Brunkwall

Keyword(s):

Cost Effectiveness ◽

Open Repair ◽

Type B ◽

Aortic Dissections

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Open and endovascular repair of type B aortic dissection in the Nationwide Inpatient Sample

Journal of Vascular Surgery ◽

10.1016/j.jvs.2010.05.008 ◽

2010 ◽

Vol 52 (4) ◽

pp. 860-866 ◽

Cited By ~ 70

Author(s):

Teviah Sachs ◽

Frank Pomposelli ◽

Robert Hagberg ◽

Allen Hamdan ◽

Mark Wyers ◽

...

Keyword(s):

Aortic Dissection ◽

Endovascular Repair ◽

Nationwide Inpatient Sample ◽

Type B ◽

Type B Aortic Dissection

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Morphologic predictors of aortic expansion in chronic type B aortic dissection

Vascular ◽

10.1177/1708538115591941 ◽

2015 ◽

Vol 24 (2) ◽

pp. 187-193 ◽

Cited By ~ 6

Author(s):

D Kotelis ◽

G Grebe ◽

P Kraus ◽

M Müller-Eschner ◽

M Bischoff ◽

...

Keyword(s):

Computed Tomography ◽

Aortic Dissection ◽

Aortic Diameter ◽

Aortic Dilatation ◽

Type B ◽

Type B Aortic Dissection ◽

True Lumen ◽

Cross Sectional ◽

Aortic Dissections

Aim To identify morphologic factors affecting aortic expansion in patients with uncomplicated type B aortic dissections. Methods Computed tomography data of 24 patients (18 male; median age: 61 years), diagnosed with acute uncomplicated type B aortic dissections between 2002 and 2013, were retrospectively reviewed. All patients had at least two computed tomography angiography scans and six months of uneventful follow-up. Computed tomography scans were assessed by two independent readers with regard to presence and number of entry tears. Thoracic and abdominal aortic diameters were derived using image processing software. Results Twenty-two of 24 patients showed aortic expansion over a median computed tomography angiographic follow-up of 33.2 months. Annual rates showed an increase of 1.7 mm for total aortic diameter, 2.1 mm for the false and a decrease of −0.4 mm for the true lumen. In three patients (12.5%), aortic diameter exceeded 60 mm during follow-up, and all three patients underwent thoracic endovascular aortic repair. Patients with a maximum aortic diameter <4 cm at baseline showed a significantly higher expansion rate compared to cases with an initial maximum aortic diameter of ≥4 cm ( p=0.0471). A median of two entries (range: 1–5) was recognized per patient. Presence of more than two entry tears ( n = 13) was associated with faster overall diameter expansion (mean annual rates: 2.18 mm vs. 1.16 mm; p = 0.4556), and decrease of the cross-sectional surface of the true lumen over time (annual rate for > 2 entries vs. ≤2 entries: −7.8 mm2 vs. +37.5 mm2; p = 0.0369). Median size of entry tears was 12 mm (range: 2–53 mm). Conclusions The results presented herein suggest that uncomplicated type B aortic dissection patients with more than two entry tears and/or an initial maximum aortic diameter of<4 cm are at risk for aortic dilatation and, therefore, may require stricter follow-up including the possible need for early intervention.

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