TY - JOUR
T1 - Outcomes following extended thoracic endovascular aortic repair for type b aortic dissection from the global registry for endovascular aortic treatment
AU - Allievi, Sara
AU - Mandigers, Tim J
AU - Weaver, Fred A
AU - Azizzadeh, Ali
AU - Piffaretti, Gabriele
AU - Schermerhorn, Marc L
AU - Magee, Gregory A
AU - Gable, Dennis R
AU - Lomazzi, Chiara
AU - Trimarchi, Santi
N1 - Publisher Copyright:
© 2025 The Author(s). Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.
PY - 2025/7
Y1 - 2025/7
N2 - OBJECTIVES This study evaluated the short- to longer-term safety and efficacy of extended thoracic endovascular aortic repair for Type B aortic dissection. METHODS We identified acute and subacute Type B dissection between 2010 and 2016 in the Global Registry for Endovascular Aortic Treatment. We stratified the population based on treatment extent: 'non-extended' (1 stent graft deployed), 'extended' (>1 stent graft deployed). Our primary outcomes were in-hospital spinal cord ischaemia and mortality. Secondarily, we evaluated procedure-related complications (endoleak, migration, fracture, compression, reinterventions), sac dynamics, rupture, and all-cause mortality at 1 and 5 years. Sensitivity analysis was performed in patients without prior aortic procedures. RESULTS Of 170 procedures, 78 (46%) were extended (median 2 [range 2-5] stent-grafts). Extended and non-extended treatment had similar rates of complicated presentations (53% vs 64%; P = 0.13). Compared with non-extended treatment, extended treatment had similar in-hospital rates of spinal cord ischaemia (2.6% vs 2.2%; P = 1) and mortality (2.6% vs 2.2%, P = 1). Additionally, extended treatment had not statistically different sac expansion rates, (1 year: 14% vs 23%, P =0.80; 5 years: 16% vs 32%, P=0.29) and rupture risk (1 year: 1.3% vs 3.3%, P = 0.63), similar procedure-related complications (endoleak, migration, fracture, compression, reinterventions; all P > 0.05) and all-cause mortality (1 year: 10% vs 7.6%, P=0.54; 5 years: 19% vs 21%, P=0.82). All outcomes remained similar on sensitivity analysis. CONCLUSIONS Our findings suggest that extended treatment for Type B aortic dissection may be associated with similar procedure-related risks and complications. Future larger studies are needed to define who might benefit from an extended treatment and further optimize patient-specific treatment for aortic dissection.
AB - OBJECTIVES This study evaluated the short- to longer-term safety and efficacy of extended thoracic endovascular aortic repair for Type B aortic dissection. METHODS We identified acute and subacute Type B dissection between 2010 and 2016 in the Global Registry for Endovascular Aortic Treatment. We stratified the population based on treatment extent: 'non-extended' (1 stent graft deployed), 'extended' (>1 stent graft deployed). Our primary outcomes were in-hospital spinal cord ischaemia and mortality. Secondarily, we evaluated procedure-related complications (endoleak, migration, fracture, compression, reinterventions), sac dynamics, rupture, and all-cause mortality at 1 and 5 years. Sensitivity analysis was performed in patients without prior aortic procedures. RESULTS Of 170 procedures, 78 (46%) were extended (median 2 [range 2-5] stent-grafts). Extended and non-extended treatment had similar rates of complicated presentations (53% vs 64%; P = 0.13). Compared with non-extended treatment, extended treatment had similar in-hospital rates of spinal cord ischaemia (2.6% vs 2.2%; P = 1) and mortality (2.6% vs 2.2%, P = 1). Additionally, extended treatment had not statistically different sac expansion rates, (1 year: 14% vs 23%, P =0.80; 5 years: 16% vs 32%, P=0.29) and rupture risk (1 year: 1.3% vs 3.3%, P = 0.63), similar procedure-related complications (endoleak, migration, fracture, compression, reinterventions; all P > 0.05) and all-cause mortality (1 year: 10% vs 7.6%, P=0.54; 5 years: 19% vs 21%, P=0.82). All outcomes remained similar on sensitivity analysis. CONCLUSIONS Our findings suggest that extended treatment for Type B aortic dissection may be associated with similar procedure-related risks and complications. Future larger studies are needed to define who might benefit from an extended treatment and further optimize patient-specific treatment for aortic dissection.
KW - thoracic endovascular aortic repair
KW - Type B aortic dissection
KW - spinal cord ischaemia
KW - sac dynamics
KW - GREAT registry
KW - long-term outcomes
UR - https://www.scopus.com/pages/publications/105011518564
U2 - 10.1093/icvts/ivaf156
DO - 10.1093/icvts/ivaf156
M3 - Article
C2 - 40674576
SN - 2753-670X
VL - 40
JO - Interdisciplinary cardiovascular and thoracic surgery
JF - Interdisciplinary cardiovascular and thoracic surgery
IS - 7
M1 - ivaf156
ER -