Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial

Circ Cardiovasc Interv. 2013 Aug;6(4):407-16. doi: 10.1161/CIRCINTERVENTIONS.113.000463. Epub 2013 Aug 6.


Background: Thoracic endovascular aortic repair (TEVAR) represents a therapeutic concept for type B aortic dissection. Long-term outcomes and morphology after TEVAR for uncomplicated dissection are unknown.

Methods and results: A total of 140 patients with stable type B aortic dissection previously randomized to optimal medical treatment and TEVAR (n=72) versus optimal medical treatment alone (n=68) were analyzed retrospectively for aorta-specific, all-cause outcomes, and disease progression using landmark statistical analysis of years 2 to 5 after index procedure. Cox regression was used to compare outcomes between groups; all analyses are based on intention to treat. The risk of all-cause mortality (11.1% versus 19.3%; P=0.13), aorta-specific mortality (6.9% versus 19.3%; P=0.04), and progression (27.0% versus 46.1%; P=0.04) after 5 years was lower with TEVAR than with optimal medical treatment alone. Landmark analysis suggested a benefit of TEVAR for all end points between 2 and 5 years; for example, for all-cause mortality (0% versus 16.9%; P=0.0003), aorta-specific mortality (0% versus 16.9%; P=0.0005), and for progression (4.1% versus 28.1%; P=0.004); Landmarking at 1 year and 1 month revealed consistent findings. Both improved survival and less progression of disease at 5 years after elective TEVAR were associated with stent graft induced false lumen thrombosis in 90.6% of cases (P<0.0001).

Conclusions: In this study of survivors of type B aortic dissection, TEVAR in addition to optimal medical treatment is associated with improved 5-year aorta-specific survival and delayed disease progression. In stable type B dissection with suitable anatomy, preemptive TEVAR should be considered to improve late outcome.

Clinical trial registration url: http://www.clinicaltrials.gov. Unique identifier: NCT01415804.

Keywords: aortic dissection; aortic remodeling; prognosis; stent graft.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aorta, Thoracic / pathology
  • Aortic Aneurysm, Thoracic / mortality
  • Aortic Aneurysm, Thoracic / pathology
  • Aortic Aneurysm, Thoracic / surgery*
  • Aortic Dissection / mortality
  • Aortic Dissection / pathology
  • Aortic Dissection / surgery*
  • Blood Vessel Prosthesis Implantation / methods*
  • Disease Progression
  • Female
  • Humans
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Stents*

Associated data

  • ClinicalTrials.gov/NCT01415804