Extended thoracic endovascular aortic repair is optimal therapy in acute complicated type B dissection.

Autor:	Nissen AP; Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA., Huckaby LV; Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA., Duwayri YM; Division of Vascular Surgery, Emory University School of Medicine, Atlanta, GA., Jordan WD Jr; Division of Vascular Surgery, Emory University School of Medicine, Atlanta, GA., Farrington WJ; Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA., Keeling WB; Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA., Leshnower BG; Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA. Electronic address: bleshno@emory.edu.
Jazyk:	angličtina
Zdroj:	Journal of vascular surgery [J Vasc Surg] 2024 Oct; Vol. 80 (4), pp. 1055-1063. Date of Electronic Publication: 2024 May 14.
DOI:	10.1016/j.jvs.2024.05.009
Abstrakt:	Background: Thoracic endovascular aortic repair (TEVAR) represents optimal therapy for complicated acute type B aortic dissection (aTBAD). Persistent knowledge gaps remain, including the optimal length of aortic coverage, impact on distal aortic remodeling, and fate of the dissected abdominal aorta. Methods: Review of the Emory Aortic Database identified 92 patients who underwent TEVAR for complicated aTBAD from 2012 to 2018. Standard TEVAR covered aortic zones 3 and 4 (from the left subclavian to the mid-descending thoracic aorta). Extended TEVAR fully covered aortic zones 3 though 5 (from the left subclavian to the celiac artery). Long-term imaging, clinical follow-up, and overall and aortic-specific mortality were reviewed. Results: Extended TEVAR (n = 52) required a greater length of coverage vs standard TEVAR (n = 40) (240 ± 32 mm vs 183 ± 23 mm; P < .01). In-hospital mortality occurred in 5.4% of patients (7.7% vs 2.5%; P = .27) owing to mesenteric malperfusion (n = 3) or rupture (n = 2). The overall incidences of postoperative stroke, transient paraparesis, paraplegia, and dialysis were 5.4% (3.9% vs 7.5%; P = .38), 3.2% (5.8% vs 0%; P = .18), 0%, and 0% respectively, equivalent between groups. Follow-up was 96.6% complete to a mean of 6.1 years (interquartile range, 3.5-8.6 years). There were significantly higher rates of complete thrombosis or obliteration of the entire thoracic false lumen after Extended TEVAR (82.2% vs 51.5%; P = .04). Distal aortic reinterventions were less frequent after extended TEVAR (5.8% vs 20%; P = .04). Late aorta-specific survival was 98.1% after extended TEVAR vs 92.3% for standard TEVAR (P = .32). Conclusions: Extended TEVAR for complicated aTBAD is safe, results in a high rate of total thoracic false lumen thrombosis/obliteration, and reduces distal reinterventions. Longer-term follow-up will be needed to demonstrate a survival benefit compared to limited aortic coverage. Competing Interests: Disclosures Y.M.D. is a consultant for Cook Medical. W.D.J. is a consultant for W. L. Gore & Associates, Medtronic, Cook Medical, and Endologix (consultant). B.G.L. is a consultant for Medtronic and Endospan. (Copyright © 2024 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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