Complicated acute type B thoracic aortic dissections: endovascular treatment for visceral malperfusion and pseudoaneurysms.

Naughton, Peter A; Garcia-Toca, Manuel; Matsumura, Jon S; Rodriguez, Heron E; Morasch, Mark D; Resnick, Scott A; Eskandari, Mark K

PURPOSE Morbidity and mortality of acute type B thoracic aortic dissections remain alarmingly high. Endoluminal options are promising. METHODS A single-center 5-year review of 17 acute type B aortic dissections complicated by visceral malperfusion (11) or pseudoaneurysm formation (6) treated with endovascular intervention. Interventional techniques included endografting (15) and/or percutaneous fenestration (4). Median follow-up is 28 months (range 0-76 months). RESULTS Median age was 55 years; 30-day death, stroke, and paraplegia rates were 0%, 17.6%, and 5.9%. Success reversing visceral ischemia or sealing a pseudoaneurysm was 100%. Cross-sectional imaging demonstrated that the false lumen was thrombosed in 9 patients, partially thrombosed in 6 patients. Late events include 1 delayed proximal type I endoleak, 1 delayed rupture of the thoracic aorta requiring successful emergent open surgical repair, and 2 unrelated late deaths. CONCLUSION Endovascular approaches to type B dissections presenting with visceral malperfusion and/or pseudoaneurysm can achieve acceptable early results.