Complicated acute type B aortic dissection: Midterm results of emergency endovascular stent–grafting

ObjectiveThis study assessed midterm results of emergency endovascular stent–grafting for patients with life-threatening complications of acute type B aortic dissection.MethodsBetween November 1996 and June 2004, 16 patients with complicated acute type B aortic dissections (mean age 57 years, range 16–88 years) underwent endovascular stent–grafting within 48 hours of presentation. Complications included contained rupture, hemothorax, refractory chest pain, and severe visceral or lower limb ischemia. Stent–graft types included custom-made first-generation endografts and second-generation commercial stent–grafts (Gore Excluder or TAG; W. L. Gore & Associates, Inc, Flagstaff, Ariz.). Follow-up was 100% complete, averaged 36 ± 36 months, and included postprocedural surveillance computed tomographic scans.ResultsEarly mortality was 25% ± 11% (70% confidence limit), with no late deaths. No new neurologic complications occurred. According to the latest scan, 4 patients (25%) had complete thrombosis of the false lumen; the lumen was partially thrombosed in 6 patients (38%). Distal aortic diameter was increased in only 1 patient. Actuarial survival at 1 and 5 years was 73% ± 11%; freedom from treatment failure (including aortic rupture, device fault, reintervention, aortic death, or sudden, unexplained late death) was 67% ± 14% at 5 years.ConclusionWith follow-up to 9 years, endovascular stent–grafting for patients with complicated acute type B aortic dissection conferred benefit. Consideration of emergency stent–grafting may improve the dismal outlook for these patients; future refinements in stent–graft design and technology and earlier diagnosis and intervention should be associated with improved results.