Endovascular stent-grafts treatment in acute aortic dissection (type B): Clinical outcomes during early, late, or chronic phases

Objective: This is a prospective study to evaluate the clinical outcomes of endovascular repair in patients with different phases of type B aortic dissection. Background: Endovascular repairing with stent-grafts is an innovative technique for type B acute aortic dissection. There is no previous study regarding outcomes in different time phases. Methods: Sixty-two patients underwent endovascular stent-grafts. There were 23 in the early phase (<24 hr), 20 in the late phase (≥24 hr to 2 weeks), and 19 in the chronic phase (>2 weeks). Results: The early phase group had the lowest ratio of stent-grafts to patient and the shortest stent-graft length. The chronic phase group had the largest diameter of false lumen. The technical success rate was 100%; no patient died within hospital. Three patients died within 30 days, with the same death rate in every group. Compared with acute patients, the chronic group had a higher volume of contrast, a higher creatinine post-procedure, and a higher incidence of contrast-induced nephropathy. Multiple regression analysis demonstrated that creatinine and endoleak were independent factors in predicting late death (95% CI, 3.4-26%, P < 0.01). The overall cardiovascular event-free survival was 88.9% ± 2.1% at 30 days, 87.2% ± 4.1% at 1 year, and 81.4% ± 6.3% at 2 years. CT angiography identified the complete or partial thrombosis of the false lumen to be 95.7%. Conclusions: Endovascular repairing with stent-graft is safe, feasible, and able to treat type B aortic dissection in all phases. However, chronic renal dysfunction was an independent factor which contributed to a lower survival rate of chronic phase patients.