Safety and efficacy of thoracic endovascular aortic repair for acute Stanford type B aortic dissection with retrograde type A intramural hematoma.

OBJECTIVE: To evaluate safety and efficacy of thoracic endovascular aortic repair (TEVAR) for acute Stanford type B aortic dissection (TBAD) with retrograde type A intramural hematoma (TAIMH).

METHODS: Patients with acute TBAD with retrograde TAIMH treated with TEVAR between 1 January 2014 to 31 March 2022 were retrospectively reviewed. Aortic diameter and distance were measured using the 3D Slicer image computing platform. Patients' characteristics, procedural, in-hospital and follow-up data, and aortic remodeling were analyzed.

RESULTS: 52 patients (average age 52.6 years; 42 males [80.8%]) were included. The median (interquartile range) interval from symptom onset to TEVAR was 11 (7.0-16.8) days. The maximal diameter of the ascending aorta (AA) was <50 mm and the hematoma thickness in the AA was ≤10 mm in all patients. Both the in-hospital and 30-day mortality rates were 0%. The 30-day complication rate was 11.5%. The overall cumulative survival rates were 100% at 1-year, 97.1% at 3-years, and 92.6% at 5-years. 4 of 52 (7.7%) patients developed retrograde type A aortic dissection at 10 days to 4 months postoperatively, and 1 of 52 (1.9%) patients developed an isolated AA dissection 4 months postoperatively; these 5 patients were treated and alive at late follow-up in March 2022. The rates of cumulative freedom from thoracic aortic re-intervention were 93.7% at 1-year and 90.7% at 5-years. Positive AA remodeling was observed in 92.3% (48/52) of patients during follow-up. The maximal diameter of AA (mean ± standard error of mean) at admission was 42.7 ± 0.8 mm, which decreased to 39.5 ± 0.9 mm at last follow-up. The maximal AA hematoma thickness at admission was 7.6 ± 0.3 mm, which reduced to 2.2 ± 0.9 mm at last follow-up.

CONCLUSIONS: For selected patients of acute Stanford TBAD with retrograde TAIMH, endovascular repair may be a safe, effective, and durable alternative treatment, if the maximum diameter of the AA is <50 mm and the IMH thickness in the AA is ≤10 mm.