DOI: 10.1161/circ.148.suppl_1.13748 ISSN: 0009-7322

Abstract 13748: Safety and Efficacy of Extended Endovascular Treatment for Acute Type B Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection

Sara Allievi, Santi Trimarchi, Joseph S Coselli, Ibrahim Sultan, Derek R Brinster, Joseph E Bavaria, Bradley G Leshnower, Puja Kachroo, Arminder Jassar, Raffi Bekeredjian, Chih Wen pai, Davide Pacini, Truls Myrmel, Kim A Eagle, Himanshu J Patel, Marc Schermerhorn
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: Prior studies reported that extended TEVAR could improve false lumen remodeling in acute type B aortic dissection (TBAAD). However, extended aortic coverage is also a risk factor for spinal cord ischemia (SCI). This study aimed to evaluate the safety and efficacy of extended TEVAR for TBAAD.

Methods: Patients who underwent TEVAR for TBAAD between 01/2002-01/2023 in the IRAD Interventional Cohort were analyzed and stratified based on treatment extent: “extended” if aortic coverage > 200 mm, “not-extended” if ≤ 200 mm. Patients with prior aortic repair were excluded. We assessed postoperative SCI and mortality with univariate analysis. Secondly, we compared mid-term outcomes with cumulative incidence function (Gray's test) and Kaplan-Meier estimate (log-rank test).

Results: Of 4,146 TBAADs, 350 met inclusion criteria. Compared with not-extended patients (173, 50.3%), patients with extended TEVAR (171, 49.7%) were more frequently Black (29.9% vs. 16.6%; p=.006) and less frequently had aortic valve disease (1.4% vs. 6.5%; p=.03). The indication for extended TEVAR was more frequently extension of incident dissection (15.5% vs. 5.5%; p=.02). Extended TEVAR more frequently had proximal seal in the arch (60.6% vs. 48.2%; p=.03), and distal seal in the thoraco-abdominal (22.1% vs. 7.6%; p=.002), or infrarenal aorta (10.8% vs. 3.5%; p=.02). Extended TEVAR had higher rates of postoperative SCI (6.7% vs. 3.8%; p=.31) and mortality (9.9% vs. 6.4%; p=.24), although the difference was small and not significant. Moreover, after median follow-up of 23.8 months, extended TEVAR had different estimates (albeit not significant) for 3-year complete false lumen thrombosis (48.9% vs. 40.2%; p=.79), 4-year reoperation (13.3% vs. 7.7%; p=.35), and aortic growth (74.6% vs. 47.0%; p=.70), but similar survival (84.7% vs. 83.0%; p=.84).

Conclusions: Extension of incident dissection was more common in the extended TEVAR patients.. Although these patients had almost double the rate of SCI, this wasn’t significant. Our findings suggest that extended and not extended treatment for TBAAD may have similar postoperative and mid-term outcomes. Further studies with bigger sample size, and longer follow-up are needed to confirm these results.

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