Early Thoracic Endovascular Aortic repair (TEVAR) in Acute Type B Aortic Dissection with Malperfusion Syndrome Mitigates the Risks of Severe Complications
Cenea Kemp, Zihan Feng, T. Brett Reece, Muhammad Aftab.
University of Colorado, Denver, CO, USA.
Introduction:Patients presenting with acute type B aortic dissection are at increased risk for postoperative complications. It is presumed that these risks are even higher in patients presenting with clinical malperfusion syndrome. We sought to demonstrate that Type B dissection patients with malperfusion syndrome face no increased risk for inferior outcomes following Thoracic Endovascular aortic repair (TEVAR) with early intervention.
Methods: Using our institutional database, all patients presenting with type B aortic dissection and subsequently underwent TEVAR between November 2010 and May 2021 were identified. We categorized the patients into malperfusion and non-malperfusion groups based on the presence of cerebral, visceral, renal, spinal cord, and extremity ischemia on presentation.Results: Seventy patients presented with a type B aortic dissection and underwent TEVAR. Of these, 13 presented with the malperfusion syndrome, whereas the remaining 57 patients had no evidence of malperfusion on arrival. The preoperative characteristics were similar between both groups. There were no differences in the postoperative complications. However, patients with malperfusion had significantly prolonged intensive care unit length of stay (P 0.0009). There was one death (7.7%) in the malperfusion group, and six patients (5.3%) died in the non-malperfusion group (P=0.99).
Conclusion: Although the patients with type B dissection and clinical malperfusion syndrome are critically ill, our experience demonstrates that the postoperative outcomes of thoracic endovascular aortic repair between both groups are similar. Despite the protracted recovery, early identification and prompt surgical intervention in patients with malperfusion syndrome could be lifesaving and minimize the burden of significant complications.
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