Combined proximal stent grafting plus distal bare metal stenting for management of aortic dissection: Superior to standard endovascular repair?

Objectives: The present study compared the outcomes between combined proximal descending aortic endografting plus distal bare metal stenting and conventional proximal descending aortic stent-graft repair in patients with type A and type B aortic dissection. Methods: From January 2003 to December 2010, 63 patients underwent endovascular treatment for acute (type A, 24; type B, 21) and chronic (type B, 18) aortic dissection. Of these, 40 patients underwent proximal descending aortic endografting plus distal bare metal stenting (group 1), and 23 underwent proximal descending stent-graft repair alone (group 2). All patients with type A dissection underwent open surgical intervention plus adjunctive retrograde endovascular repair. Results: The patients were comparable for baseline characteristics and treatment indicators, but more group 1 patients were active smokers (P=.03). The intraoperative characteristics were also similar, although 4 patients, all in group 2, developed malperfusion syndrome postoperatively (P=.02). The overall hospital mortality was 6%. At a mean follow-up of 49 months, 9 group 2 patients (43%) required unplanned secondary intervention compared with 4 in group 1 (11%; P=.007). Reintervention for thoracoabdominal aortic aneurysm or visceral ischemia was performed in 4 patients (19%) from group 2 (P=.03). Late aortic-related deaths occurred in 1 (5%) and 2 (5%) patients in groups 1 and 2, respectively. Conclusions: Combined proximal descending aortic endografting plus distal bare metal stenting for aortic dissection provides favorable short-term outcomes and decreases late distal aortic complications compared with conventional endovascular repair. These results support a more widespread application of this approach. A prospective, randomized trial is needed before definite conclusions can be made. (J Thorac Cardiovasc Surg 2012; 144: 956-62)