Best medical treatment vs endovascular repair for uncomplicated acute type B aortic dissection: a comparative study.

Abstract

Introduction: Both best medical treatment (BMT) and endovascular repair (ER) are viable treatment strategies in uncomplicated acute type B aortic dissection (TBAD). However, long-term outcomes of these 2 approaches remain a topic of debate.

Aim: This study was developed to compare the clinical efficacy, short-term outcomes, and long-term results of ER and BMT in the management of uncomplicated TBAD.

Materials and methods: This retrospective, single-center study included consecutive individuals diagnosed with uncomplicated TBAD who underwent ER or BMT between January 2019 and August 2024. Relative outcomes for these 2 treatment approaches were compared.

Result: In total, 165 and 148 patients who respectively received ER and BMT were enrolled in the analysis. Relative to BMT, ER significantly increased the thrombosed / obliterated false lumen rate (81.8% vs 16.2%, respectively; P = 0.001), reduced the rupture rate (1.8% vs 12.2%, respectively; P = 0.001), and decreased late mortality (4.8% vs 14.2%, respectively; P = 0.004). The rates of retrograde type A dissection, organ failure, and early mortality in the BMT and ER groups were similar (1.8% vs 3.4%; P = 0.48; 0.6% vs 2%; P = 0.35; 0.6% vs 4.1%; P = 0.06, respectively). In the ER group, the overall survival rates at 1, 3, and 5 years were 98.8%, 96.5%, and 94.6%, respectively, while the BMT group exhibited corresponding survival rates of 94.5%, 91.5%, and 84.7%.

Conclusion: In comparison with BMT, ER significantly reduces rupture rate and enhances thrombosed / obliterated false lumen rate, thereby improving long-term prognosis.