Endovascular Repair or Medical Treatment of Acute Type B Aortic Dissection? A Comparison

Eur J Radiol. 2010 Jan;73(1):175-80. doi: 10.1016/j.ejrad.2008.09.031. Epub 2008 Nov 8.

Abstract

Introduction: The aim of this retrospective study was to compare the outcome of thoracic endovascular aortic repair (TEVAR) to that of medical therapy in patients with acute type B aortic dissection (TBD).

Materials and methods: From July 1996 to April 2008, 88 patients presenting with acute TBD underwent either TEVAR (group A, n=38) or medical therapy (group B, n=50). Indications for TEVAR were intractable pain, aortic branch compromise resulting in end-organ ischemia, rapid aortic dilatation and rupture. Follow-up was performed postinterventionally, at 3, 6 and 12 months and yearly thereafter and included clinical examinations and computed tomography (CT), as well as aortic diameter measurements and assessment of thrombosis.

Results: Mean follow-up was 33 months in group A and 36 months in group B. The overall mortality rate was 23.7% in group A and 24% in group B, where 4 patients died of late aortic rupture. In group A, complications included 9 endoleaks and 4 retrograde type A dissections, 3 patients were converted to open surgery and 2 needed secondary intervention. None of the patients developed paraplegia. In group B, 4 patients were converted to open surgery and 2 to TEVAR. The maximal aortic diameter increased in both groups. Regarding the extent of thrombosis, our analyses showed slightly better overall results after TEVAR, but they also showed a tendency towards approximation between the two groups during follow-up.

Conclusion: TEVAR is a feasible treatment option in acute TBD. However, several serious complications may occur during and after TEVAR and it should therefore be reserved to patients with life-threatening symptoms.

Publication types

  • Comparative Study
  • Controlled Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aneurysm, Dissecting / diagnosis
  • Aneurysm, Dissecting / therapy*
  • Aortic Aneurysm / diagnosis
  • Aortic Aneurysm / therapy*
  • Blood Vessel Prosthesis*
  • Fibrinolytic Agents / administration & dosage*
  • Humans
  • Middle Aged
  • Stents*
  • Vascular Surgical Procedures / methods*

Substances

  • Fibrinolytic Agents