The following is the summary of “Endovascular treatment of complicated versus uncomplicated acute type B aortic dissection” published in the January 2023 issue of Thoracic and cardiovascular surgery by Spinelli, et al.
The purpose of this study was to compare the results of thoracic endovascular aortic repair in patients with and without complications following acute type B aortic dissection. Patients with acute type B aortic dissections with thoracic endovascular aortic repair were included in a retrospective analysis of data from WL Gore’s Global Registry for Endovascular Aortic Treatment. To treat their acute type B aortic dissections, 172 individuals from the Global Registry for Endovascular Aortic Treatment (n=5,014) received thoracic endovascular aortic repair. There were a total of 152 aortic repairs performed, 102 for acute type B aortic dissections with complications and 70 for acute type B aortic dissections without complications.
Aortic branch vessel procedures accounted for 45.1% of all surgeries, compared to 21.4% for complex and uncomplicated type B aortic dissections (P=.002). Patients with problematic type B aortic dissections stayed in the hospital for a significantly longer time than those with uncomplicated acute type B aortic dissections, with a mean length of stay of 14.3± 10.6 days (median, 11; range, 2-75; P<.001) versus 9.8 ± 7.9 days (median, 8; range, 0-42). Mortality at 30 days was similar for both groups (2.9% for difficult type B aortic dissections and 1.4% for simple acute type B aortic dissections, P=.647), and the same was true for aortic complications (8.8% vs. 5.7%, P=.449). At 3 years, aortic event-free survival was 62.9%± 37.1% versus 70.6% ±29.3% (P=.696).
Both 30-day mortality and perioperative complications after thoracic endovascular aortic repair were low for difficult and uncomplicated acute type B aortic dissections in the Global Registry for Endovascular Aortic Treatment. A good result was achieved by the midpoint. This evidence supports thoracic endovascular aortic repair as the initial treatment option for difficult type B dissections. Thoracic endovascular aortic repair may be preferable to medical therapy for simple, acute type B dissections, however, this remains to be determined in larger studies with longer follow-up periods. Results from registries of patients with uncomplicated acute type B aortic dissection who were treated with thoracic endovascular aortic repair are significant for understanding the associated risk and benefit in the absence of level A data from randomized trials.