Five-year outcomes after thoracic endovascular aortic repair of symptomatic type B penetrating aortic ulcer with intramural hematoma in Chinese patients

Background: The aim of this study is to evaluate the five-year outcomes after thoracic endovascular aortic repair (TEVAR) of symptomatic Stanford type B penetrating aortic ulcer (PAU) associated with intramural hematoma (IMH) in Chinese patients. Methods: From January 2009 to April 2013, 118 patients with typical severe acute chest pain were diagnosed with Stanford type B acute aortic syndrome (AAS) in our department and received TEVAR. Within the group, 28 patients were diagnosed with PAU associated with IMH by computed tomography angiography (CTA) and subsequently evaluated with repeated CTA. All 28 patients' clinical and follow-up data were collected for 60 months. Results: PAU associated with IMH continued to progress for approximately 14 days and sometimes a few days more. Twenty-eight patients underwent TEVAR under general anesthesia via femoral artery access. Technical success was achieved in 100% of cases. Two stent grafts were used in 1 patient to achieve effective coverage of the PAUs and IMH. The follow-up rate was 92.8%. Two patients were lost to follow-up in the 4th and 16th months due to relocation. All patients remained free of aortic symptoms during follow-up. Two heavy smoker patients in whom the ostium of the left subclavian artery (LSCA) was completely covered by the graft had transient dizziness upon resumption of smoking during follow-up. There were 2 early type II endoleaks but no aortic expansion. No patient needed reintervention. One patient died in a car accident at 42 months. Four patients safely underwent noncardiovascular surgery. The 1-, 2-, and 5-year overall survival rates were 100%, 100%, and 96.1%, respectively. Conclusions: The short- and mid-term results of TEVAR treatment for symptomatic Stanford type B PAU associated with IMH in Chinese patients were encouraging. Long-term follow-up is anticipated.