Risk factors and treatment outcomes for type B aortic dissection with malperfusion requiring adjunctive procedures after thoracic endovascular aortic repair.

Abstract

OBJECTIVE:

To investigate the risk factors for unrelieved malperfusion after thoracic endovascular aortic repair (TEVAR) alone.

METHODS:

From January 2009 to December 2019, 86 patients with type B aortic dissection-induced malperfusion were enrolled. Demographics and clinical and imaging data, as well as treatment outcomes, were collected and compared between patients with malperfusion relieved by TEVAR alone (TR) or by TEVAR with adjunctive procedures (TA).

RESULTS:

Among the 86 enrolled patients, 17 (19.8%) had malperfusion requiring TA. Patients in the TA group were more likely to suffer lower limb ischemia (P = .004), present with severe ischemia (P = .003), and have more than one end-organ ischemia (P = .015). There were more involved vessels classified as the mixed type in the TA group (P = .002). Mixed ischemia was the only independent risk factor for malperfusion requiring TA (odds ratio, 4.7; 95% confidence interval [CI], 1.3-17.2; P = .017). The ischemia-related in-hospital mortality rate of the TA group was significantly higher than that of the TR group (P = .023), and malperfusion requiring TA was the only risk factor in the multivariate logistic regression (odds ratio, 14.6; 95% CI, 1.4-150.5; P = .025). The 5-year overall cumulative survival rates were 82.4% (95% CI, 66.1%-100.0%) in the TA group and 89.5% (95% CI, 81.6%-98.1%) in the TR group (P = .294).

CONCLUSIONS:

Type B aortic dissection-induced malperfusion requiring TA was associated with a higher ischemia-related in-hospital mortality rate. Mixed obstruction was an independent risk factor for unrelieved malperfusion after TEVAR alone, and early identification of potential patients requiring TA could thereby be achieved. Reasonable treatment strategies could contribute to the successful management of malperfusion requiring TA.

• Authors: Yifan Liu, Xiaolang Jiang, Bin Chen, Junhao Jiang, Tao Ma, Zhihui Dong, Weiguo Fu
• Journal: Journal of vascular surgery (J Vasc Surg) Vol. 75 Issue 4 Pg. 1192-1200.e2 (04 2022) ISSN: 1097-6809 [Electronic] United States
• PMID: 34655681 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Topics

• Aortic Dissection (complications, diagnostic imaging, surgery)
• Aortic Aneurysm, Thoracic (complications, diagnostic imaging, surgery)
• Blood Vessel Prosthesis Implantation (adverse effects)
• Endovascular Procedures (adverse effects)
• Humans
• Ischemia (diagnostic imaging, etiology, surgery)
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome