Early outcomes after endovascular management of acute, complicated type B aortic dissection

Objectives: Surgical management of acute, complicated type B aortic dissection is associated with significant morbidity and mortality. This study examined the feasibility and safety of endovascular treatment of this pathology. Methods. We reviewed a prospectively maintained thoracic endovascular database and medical records at a single institution from 2005 to 2007. The study group comprised of acute, complicated type B dissections, defined as duration of symptoms :514 days and involving either false lumen rupture, malperfusion, intractable pain, or uncontrolled hypertension. All repairs were performed using the TAG device (W. L. Gore and Associates, Flagstaff, Ariz). Select 30-day or in-hospital outcomes were reported. Results. Of the 216 thoracic endovascular aortic aneurysm repairs performed during the study period, 33 (15%) were for acute, complicated type B dissections. There were eight women (24%). The mean age was 61 +/- 15 years. The average duration of symptoms was 2.9 +/- 4.1 (median, 1) days. The indications for repair included rupture in 15 patients (46%) and mesenteric/renal/lower extremity malperfusion in 11 (33%). Mean fluoroscopy time and contrast volume were 30 16 minutes and 176 +/- 55 mL, respectively. Eight (73%) of I I patients with malperfusion required branch vessel stenting. The 30-day in-hospital mortality was 21% (7 of 33). Causes of death included cardiac arrest in 3, progressive multisystem organ failure in 2, rupture in I and unknown in 1. At least one major complication occurred in 76% of the patients, including respiratory failure in 11 (33%), permanent spinal cord ischemia in 5 (15%), renal failure requiring dialysis in 4 (12%), and stroke in 4 (12%). The mean postoperative length of stay was 17.2 +/- 16.5 days, and only 14 (42%) were discharged to home. Conclusions. Emergency endovascular repair of acute, complicated type B dissection is associated with significant mortality and morbidity. The overall role of this therapy in the treatment of this lethal problem should be better defined and compared with other surgical or interventional options before being generally adopted. (J Vasc Surg 2009;49:561-7.)