Midterm Clinical Outcomes of Endovascular Treatment for Acute Aortic Dissection with Malperfusion Syndrome.

Abstract

Purpose: There is limited data on the midterm results of endovascular treatment for acute type B aortic dissection (TBAD) with malperfusion syndrome (MS), particularly in Asia. This study aimed to investigate the clinical outcomes of endovascular treatment of acute TBAD with MS.

Materials and methods: We retrospectively analyzed 27 patients who underwent endovascular treatment for acute TBAD with MS.

Results: Among the 27 patients with TBAD and MS, malperfusion was observed in the isolated renal (44.4%), visceral (7.4%) and iliofemoral (25.9%) arteries, as well as their combinations (22.2%). The patients underwent thoracic endovascular aortic repair (TEVAR) only (25.9%), selective stenting only in arteries affected by malperfusion (22.2%), or combined treatment with TEVAR and selective stenting (51.9%). Primary technical success was achieved in all the patients. No inhospital mortality or early death within 30 days after operation occurred. The rates of stroke, limb ischemia, acute kidney injury, and reintervention at 30 days were 7.4%, 3.7%, 25.9%, and 3.7%, respectively. The mean follow-up period was 4.3±3.1 years. During the follow-up, the rates of death, stroke, maintenance hemodialysis, aneurysmal change, and reintervention were 0%, 3.7%, 7.4%, 7.4%, and 7.4%, respectively. Two patients required reintervention due to limb ischemia and aneurysmal changes in the distal portion of the stent graft. Computed tomography scans revealed a significant increase in aortic diameters in patients who underwent selective stenting compared to those who underwent TEVAR over a 3-year period, with changes in aortic area measuring 878.9 mm² vs. 188.4 mm² at the middle of the lesion (P=0.037), 303.7 mm² vs. 22.8 mm² at the level of the celiac trunk (P=0.025), and 442.9 mm² vs. 37.3 mm² at the level of the renal artery (P=0.019).

Conclusion: The endovascular treatment of acute TBAD with MS demonstrated a high primary technical success rate and promising short- and midterm clinical outcomes.