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Observational Study
. 2025 Jul 3;40(7):ivaf156.
doi: 10.1093/icvts/ivaf156.

Outcomes following extended thoracic endovascular aortic repair for Type B aortic dissection from the global registry for endovascular aortic treatment

Sara Allievi  1   2 , Tim J Mandigers  1   2   3 , Fred A Weaver  4 , Ali Azizzadeh  5 , Gabriele Piffaretti  6 , Marc L Schermerhorn  2 , Gregory A Magee  4 , Dennis R Gable  7 , Chiara Lomazzi  1 , Santi Trimarchi  1   8
Affiliations
Observational Study

Outcomes following extended thoracic endovascular aortic repair for Type B aortic dissection from the global registry for endovascular aortic treatment

Sara Allievi et al. Interdiscip Cardiovasc Thorac Surg. .

Abstract

Objectives: This study evaluated the short- to longer-term safety and efficacy of extended thoracic endovascular aortic repair for Type B aortic dissection.

Methods: We identified acute and subacute Type B dissection between 2010 and 2016 in the Global Registry for Endovascular Aortic Treatment. We stratified the population based on treatment extent: 'non-extended' (1 stent graft deployed), 'extended' (>1 stent graft deployed). Our primary outcomes were in-hospital spinal cord ischaemia and mortality. Secondarily, we evaluated procedure-related complications (endoleak, migration, fracture, compression, reinterventions), sac dynamics, rupture, and all-cause mortality at 1 and 5 years. Sensitivity analysis was performed in patients without prior aortic procedures.

Results: Of 170 procedures, 78 (46%) were extended (median 2 [range 2-5] stent-grafts). Extended and non-extended treatment had similar rates of complicated presentations (53% vs 64%; P = 0.13). Compared with non-extended treatment, extended treatment had similar in-hospital rates of spinal cord ischaemia (2.6% vs 2.2%; P = 1) and mortality (2.6% vs 2.2%, P = 1). Additionally, extended treatment had not statistically different sac expansion rates, (1 year: 14% vs 23%, P =0.80; 5 years: 16% vs 32%, P=0.29) and rupture risk (1 year: 1.3% vs 3.3%, P = 0.63), similar procedure-related complications (endoleak, migration, fracture, compression, reinterventions; all P > 0.05) and all-cause mortality (1 year: 10% vs 7.6%, P=0.54; 5 years: 19% vs 21%, P=0.82). All outcomes remained similar on sensitivity analysis.

Conclusions: Our findings suggest that extended treatment for Type B aortic dissection may be associated with similar procedure-related risks and complications. Future larger studies are needed to define who might benefit from an extended treatment and further optimize patient-specific treatment for aortic dissection.

Keywords: GREAT registry; Type B aortic dissection; long-term outcomes; sac dynamics; spinal cord ischaemia; thoracic endovascular aortic repair.

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Conflict of interest statement

S.T. and D.R.G. are principal investigators of the GREAT; S.T. is a consultant for Terumo Aortic, Medtronic Inc., and W.L. Gore; D.R.G. is a consultant for W.L. Gore and Medtronic Inc., provides research support for W.L. Gore, Medtronic Inc. and Silk Road, and is on the Advisory Board of W.L. Gore.

Figures

None
Graphical abstract
Figure 1:
Figure 1:
Number of patients undergoing TEVAR for Type B aortic dissection, categorized by length of aortic coverage and number of deployed stent-grafts
Figure 2:
Figure 2:
Patient flowchart detailing inclusion and exclusion criteria for study cohort
Figure 3:
Figure 3:
Proportion of patients receiving extended TEVAR for Type B aortic dissection over the study period
See this image and copyright information in PMC

References

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