Filiberto Amanda C, Novak Zdenek, Azizzadeh Ali, Cronenwett Jack L, Lombardi Joseph V, Wang Grace, White Rodney, Beck Adam W
Division of Vascular Surgery and Endovascular Therapy, University of Alabama, Birmingham, AL, USA.
Division of Vascular Surgery, Cedars-Sinai Medical Centre, Los Angeles, CA, USA.
Eur J Vasc Endovasc Surg. 2025 Aug;70(2):229-236. doi: 10.1016/j.ejvs.2025.04.023. Epub 2025 Apr 10.
The Society for Vascular Surgery (SVS) and the Society for Thoracic Surgery published reporting standards defining complicated and uncomplicated type B aortic dissections (TBADs) and included previously undefined high risk features. This retrospective review of multi-institution SVS Vascular Quality Initiative (VQI) post-approval study (VQI PAS) data aimed to evaluate the outcomes of patients with high risk TBAD (hrTBAD) and complicated TBAD (cTBAD) treated with thoracic endovascular aortic repair (TEVAR).
The data of 641 patients collected from 2013 to 2023 were included. Patients were stratified by aortic dissection acuity: 191 complicated (cTBAD; defined as those with rupture or malperfusion) and 450 high risk (hrTBAD; defined as having refractory pain, refractory hypertension, or aortic diameter ≥ 40 mm). Uni- and multivariable analyses were used to determine the differences in outcomes by aortic dissection acuity for post-operative death, complications, and re-intervention.
Demographics and comorbidities were similar between the groups. A higher proportion of patients within the cTBAD group were transferred from an outside facility and had a pre-operative creatinine ≥ 1.8 mg/dL. Post-operative complications were more common in the cTBAD group. On Kaplan-Meier analysis, there was a lower 30 day, one year, and five year survival after TEVAR in the cTBAD group, but without differences in re-intervention.
Patients with cTBAD undergoing TEVAR have poorer peri-operative and long term outcomes compared with those with hrTBAD. More studies are necessary to better elucidate the implications and long term benefits of TEVAR for patients with hrTBAD.
血管外科学会（SVS）和胸外科学会发布了报告标准，定义了复杂型和非复杂型B型主动脉夹层（TBAD），并纳入了此前未定义的高风险特征。这项对多机构SVS血管质量改进计划（VQI）批准后研究（VQI PAS）数据的回顾性分析旨在评估接受胸主动脉腔内修复术（TEVAR）治疗的高风险TBAD（hrTBAD）和复杂型TBAD（cTBAD）患者的预后。
纳入2013年至2023年收集的641例患者的数据。患者按主动脉夹层的严重程度分层：191例复杂型（cTBAD；定义为有破裂或灌注不良者）和450例高风险型（hrTBAD；定义为有顽固性疼痛、顽固性高血压或主动脉直径≥40mm者）。采用单变量和多变量分析来确定术后死亡、并发症和再次干预方面，主动脉夹层严重程度在预后上的差异。
两组患者的人口统计学特征和合并症相似。cTBAD组中更高比例的患者是从外部机构转诊而来，且术前肌酐≥1.8mg/dL。cTBAD组术后并发症更常见。根据Kaplan-Meier分析，cTBAD组TEVAR术后30天、1年和5年生存率较低，但再次干预方面无差异。
与hrTBAD患者相比，接受TEVAR治疗的cTBAD患者围手术期和长期预后更差。需要更多研究来更好地阐明TEVAR对hrTBAD患者的影响和长期益处。
