Five-Year Outcomes of Endovascular Repair of Complicated Acute Type B Aortic Dissections
Bavaria et al reported the five-year outcomes of thoracic endovascular aortic repair (TEVAR) of complicated acute type B aortic dissection (TBAD) in the DISSECTION trial. In this prospective, nonrandomized study, 50 patients were treated with the Valiant Captivia thoracic stent graft for acute complicated TBAD. Prior to TEVAR, malperfusion was seen in 86% (43/50), ruptures in 20% (10/50), and DeBakey class IIIb dissections in 94% (46/49).
At five years, clinical and imaging follow-up was available in 78% (18/23); freedom from dissection-related mortality, secondary procedures related to dissection, and endoleak were 83%, 86%, and 85%, respectively; complete thrombosis of false lumen across the stented aortic segment was seen in 89% (16/18); true lumen diameter across the stent graft was stable or increased in 94% (16/17); and false lumen diameter was stable or decreased in 77% (13/17) of patients.
These results show that patients with complicated TBAD experienced positive and sustained measures of aortic remodeling after TEVAR and the Valiant Captivia thoracic stent graft system was effective in the long-term management of acute complicated type B aortic dissections in this challenging patient population.
I am always concerned that the missing follow up reflects mostly major adverse outcomes