Efficacy of thoracic endovascular stent repair for chronic type B aortic dissection with aneurysmal degeneration

摘要: Background The Food and Drug Administration has approved devices for endovascular management of thoracic aortic aneurysm repair (TEVAR); however, limited data exist describing the outcomes TEVAR aneurysms attributable to chronic type B dissection (cTBAD). This study was undertaken determine results treatment cTBAD with aneurysmal degeneration. Methods A retrospective analysis all patients treated degeneration at University Florida from 2004 2011 performed. Computed tomograms centerline reconstruction were analyzed change in diameter, relative proportions lengths, false lumen perfusion status. Reintervention mortality estimated using life-tables. Cox regression completed predict mortality. Results Eighty underwent due (mean age [± standard deviation], 60 ± 13 years [male, 87.5%; n = 70]; median follow-up, 26 [range, 1-74] months). Median time diagnosis TBAD 16 (range, 1-72) months. Prior root/arch replacement had been performed 29% (n = 23) a interval 28.5 (range, 0.5-312) Mean preoperative diameter 62.0 ± 9.9 mm. In 75% 60) cases, coverage proximal zone 3, 24% 19) carotid-subclavian bypass or other arch debranching procedure. Spinal drains used 78% (pre-op 71%, 57; post-op 6%, 5). Length stay 6.5 ± 4.7 days composite morbidity 26% in-hospital 2.5% 2). Overall neurologic event rate 17% (spinal cord ischemia 10% [n = 8], permanent deficit observed 6.2% 5]; stroke 7.5%). Aneurysm reduced stabilized 65%. thrombosed completely within aorta 52%, reintervention segment required 16% 13).One- 3-year freedom (with 95% confidence [CI]) 80% 68%-88%) 70% 57%-80%), respectively. Survival 1 5 89% 80%-94%) 55%-81%) not significantly different among requiring experiencing favorable remodeling. Multivariable identified coronary artery disease (hazard ratio [HR], 6.4; CI, 2.3-17.7; P  = .001), congestive heart failure (HR, 11.9; 1.9-73.8; .008) as independent risk factors Hyperlipidemia found be protective 0.2; 0.05-0.6; = .004). No significant difference predictors between who vs those did ( .2). Conclusions can safely but spinal rates may higher than previously reported. Liberal use procedural adjuncts reduce this complication, such drainage, is recommended. common, long-term survival does appear impacted by remediation.