Outcomes of High Risk and Complicated Type B Aortic Dissections Treated with Thoracic Endovascular Aortic Repair.

Abstract

The Society for Vascular Surgery (SVS) and the Society for Thoracic Surgery published reporting standards defining complicated and uncomplicated type B aortic dissections (TBADs) and included previously undefined high risk features. This retrospective review of multi-institution SVS Vascular Quality Initiative (VQI) post-approval study (VQI PAS) data aimed to evaluate the outcomes of patients with high risk TBAD (hrTBAD) and complicated TBAD (cTBAD) treated with thoracic endovascular aortic repair (TEVAR). The data of 641 patients collected from 2013 to 2023 were included. Patients were stratified by aortic dissection acuity: 191 complicated (cTBAD; defined as those with rupture or malperfusion) and 450 high risk (hrTBAD; defined as having refractory pain, refractory hypertension, or aortic diameter ≥ 40 mm). Uni- and multivariable analyses were used to determine the differences in outcomes by aortic dissection acuity for post-operative death, complications, and re-intervention. Demographics and comorbidities were similar between the groups. A higher proportion of patients within the cTBAD group were transferred from an outside facility and had a pre-operative creatinine ≥ 1.8 mg/dL. Post-operative complications were more common in the cTBAD group. On Kaplan-Meier analysis, there was a lower 30 day, one year, and five year survival after TEVAR in the cTBAD group, but without differences in re-intervention. Patients with cTBAD undergoing TEVAR have poorer peri-operative and long term outcomes compared with those with hrTBAD. More studies are necessary to better elucidate the implications and long term benefits of TEVAR for patients with hrTBAD.