Midterm results after endovascular treatment of acute, complicated type B aortic dissection: the Talent Thoracic Registry

Abstract

Objective: To assess the efficacy and midterm results of endovascular treatment of acute complicated type B dissection.

Methods: From January 1998 to March 2004, 29 patients (7 women and 22 men) with acute complicated aortic type B dissection (mean age, 61 years; range, 22-78), defined as aortic rupture, malperfusion, intractable pain, or uncontrolled hypertension, underwent endovascular stent graft placement with the Medtronic Talent device. Five patients (17%) had undergone previous surgery on the ascending aorta and/or aortic valve. The mean aortic diameter at intervention was 48 ± 13 mm. Follow-up was 100% complete and averaged 53 ± 41 months.

Results: The technical feasibility and success with deployment proximal to the entry tear was 100%, requiring partial or total coverage of the left subclavian artery in only 1 patient (3%). Hospital mortality was 17% ± 7% (70% confidence limit) with 6 late deaths. The causes of hospital death included multiorgan failure in 2 patients, aortic rupture in 2, and retrograde dissection in 1 patient. Three patients (10%) who survived the procedure developed neurologic complications (2 strokes and 1 transient ischemic attack). One patient required early conversion to surgery because of retrograde type A dissection. Furthermore, 4 patients developed a type Ia endoleak. A postprocedural increase in the distal aortic diameter was observed in 3 patients. The actuarial survival at 1 and 5 years was 79% and 61%, respectively. Freedom from treatment failure at 1 and 5 years (including reintervention, aortic rupture, device-related complications, aortic-related death, or sudden, unexplained late death) was 82% and 77%, respectively.

Conclusions: Endovascular stent graft placement in acute complicated type B aortic dissection proves to be a promising alternative therapeutic treatment modality in this relatively difficult patient cohort. Refinements, especially in stent design and application, could further improve the prognosis of patients in this life-threatening situation.