Outcomes of TEVAR for uncomplicated subacute type B aortic dissection in the IRAD registry.

Abstract

Background: Thoracic endovascular aortic repair (TEVAR) in uncomplicated type B acute aortic dissection (TBAAD) remains controversial. Compared to best medical therapy (BMT), TEVAR has demonstrated benefits in aortic remodeling; however, this intervention does include procedural related risks.

Methods: The International Registry of Acute Aortic Dissection (IRAD) database was queried from January 1996 to September 2023 for all uncomplicated TBAAD. Patients receiving subacute (15-90 days) TEVAR (sTEVAR) and BMT were included. Baseline comorbidities were recorded. The primary outcome was survival at 4 years. Secondary outcomes included delayed aortic interventions, progression of aortic disease, new dissection, re-hospitalization, rupture, and stroke.

Results: During the study period, 1373 uncomplicated TBAAD patients were entered into the registry and had follow-up data available. Sixty-three patients (4.6%) underwent sTEVAR and 1310 (95.4%) received BMT. Four-year survival was similar between the groups (sTEVAR 87% vs BMT 84%, p=0.925). At three years, the sTEVAR group had higher rates of new dissection (13.9% vs 4.8%, p=0.002), all within 1 year of TEVAR. Progression of dissection, aneurysmal degeneration, reintervention, rupture, stroke, and re-hospitalization were comparable between groups.

Conclusion: As compared to BMT, sTEVAR had similar rates of survival. New dissection was higher in the sTEVAR group. TEVAR may have a role in subacute uncomplicated TBAAD, and ongoing randomized trials are essential to understand which patients benefit from intervention.