Thoracic endovascular aortic repair for the treatment of ruptured acute type B aortic dissection

Purpose To evaluate the efficacy of thoracic endovascular aortic repair (TEVAR) for ruptured acute type B aortic dissection (r-ATBAD). Materials and methods The study included 18 patients (15 men and 3 women) who underwent TEVAR for r-ATBAD in two institutions between 1997 and 2017. The mean patient age was 74 ± 10 years. The false lumen was patent in 13 patients (72%) and was mostly thrombosed in 5 patients (28%). Three patients had malperfusion of aortic branches. Eight patients (44%) were in circulatory shock. Results Eleven patients (61%) died during or following TEVAR during admission. The causes of death were aortic rupture ( n = 6), sepsis ( n = 2), cerebral hypoxia ( n = 1), pneumonia ( n = 1), and renal failure ( n = 1). Statistical analysis showed that dissection extending to the infrarenal level was significantly related to death from aortic rupture ( P = 0.013). Early adverse events were observed in 12 patients (67%). One patient died from a non-aorta-related cause (sepsis) after discharge. The overall survival rate at 1 year was 39%. After discharge, an aorta-related adverse event (intimal injury) was observed in one patient. The adverse event-free survival rate at 1 year was 17%. Conclusions Our results indicate that TEVAR for r-ATBAD is associated with high mortality and morbidity. More advanced strategies may be required to improve the outcome.