Treatment of acute type-B aortic dissection: thoracic endovascular aortic repair or medical management alone?

OBJECTIVES: This study sought to evaluate the early and long-term effect of thoracic endovascular aortic repair (TEVAR) on type-B acute aortic dissection (AAD).

BACKGROUND: Uncomplicated type-B AAD is generally treated with medical management; complicated dissections require surgery or TEVAR. Studies have demonstrated that long-term outcomes with medical management are suboptimal. Therefore, we sought to determine the long-term effect of TEVAR compared with medical management alone on type-B AAD.

METHODS: From January 2004 to May 2008, 193 consecutive patients in 2 hospitals were treated and retrospectively placed into 1 of 2 groups: 1) the TEVAR group-type-B AAD treated with TEVAR and antihypertensive medications (n = 152); and the 2) medicine group-uncomplicated type-B AAD treated medically alone (n = 41). All TEVAR procedures were performed in the acute phase.

RESULTS: There were no significant differences in demographics, comorbidity profiles, or early events between groups. The cumulative freedom from all late adverse events at 1, 3, and 5 years was 97%, 89%, and 67% in the TEVAR group and 97%, 63%, and 34% in the medicine group. Log-rank tests showed that medically treated patients had more late adverse events than TEVAR-treated patients did (p = 0.003). The 5-year cumulative survival rate from all-cause death was not significantly different between the 2 groups.

CONCLUSIONS: Patients with type-B AAD treated with TEVAR experienced fewer late adverse events than those treated with medical management, but there was no significant difference among the groups in 5-year mortality rates. Further studies of longer-term survival rates are needed to determine whether TEVAR could be an effective treatment for type-B AAD.