Five-year outcomes of endovascular repair of complicated acute type B aortic dissections

ABSTRACT OBJECTIVE(S): Thoracic endovascular aortic repair (TEVAR) is the standard of care for acute complicated type B aortic dissections (TBAD) but long-term single device outcomes are limited. METHODS 50 subjects were treated with the Valiant Captivia thoracic stent graft for acute complicated TBAD in this prospective, non-randomized Dissection Trial. All-cause mortality, secondary procedures, and serious adverse events were assessed, and a Core Lab evaluated images for aortic remodeling. RESULTS Compliance for both clinical and imaging follow up was 78% (18/23) for the available subjects at five years. Notable baseline characteristics were 86% (43/50) of the subjects had malperfusion, 20% (10/50) had ruptures, and 94% (46/49) had DeBakey class IIIb dissections. The five-year freedom from dissection related mortality, secondary procedures related to the dissection, and endoleaks was 83%, 86%, and 85%, respectively. After five years, 89% (16/18) of the subjects had a completely thrombosed false lumen in the stented segment of the aorta and the true lumen diameter over the length of stent graft was stable or increased for 94% (16/17) of subjects while the false lumen diameter was stable or decreased in 77% (13/17) after five years. CONCLUSIONS In the Dissection trial, subjects experienced positive and sustained measures of aortic remodeling. Survival outcomes, need for secondary procedures, and adverse event rates were consistent with previous TEVAR studies. Although limitations exist with the follow up compliance, the Valiant Captivia thoracic stent graft system was effective in the long-term management of acute complicated type B aortic dissections in this challenging patient population.