AI Article Synopsis

  • A revolution in managing type B aortic dissection (TBAD) has occurred over the past 20 years, largely due to the introduction of thoracic endovascular aortic repair (TEVAR), though there are ongoing debates about its use, especially regarding differences between genders and ethnicities in outcomes.
  • An international study examined data from 58 TBAD patients treated with TEVAR over 17 years, focusing on demographic and clinical outcome disparities between male and female patients of different ethnicities.
  • Results indicated that while the mean age was similar, males had more complicated cases, larger proximal stent diameters, and most patients were Caucasian, highlighting a lack of significant ethnic diversity and no established risk prediction models.

Article Abstract

Background: There has been a revolution in the management of type B aortic dissection (TBAD) over the last 2 decades due to the increasing development of endovascular techniques, with the prime example being thoracic endovascular aortic repair (TEVAR). However, many controversies concerning the use of TEVAR in TBAD exist. For instance, there is little available evidence suggesting any differences in demographics, disease characteristics, intervention technicalities, and clinical outcomes between males and females as well as different ethnicities when undergoing TEVAR for TBAD, both in the short and long term. Also, there is no risk prediction model/tool available. The objective of this international study is to describe and delineate the disparities between male and female patients of different ethnicities in terms of demographics, disease and interventional characteristics, and clinical outcomes.

Methods: Over 17 years a total of 58 TBAD patients were admitted to 2 tertiary vascular centres and treated using TEVAR. Mortality, postoperative complications and reintervention data were recorded for the first 30 days after the procedure as well as during follow-up. Follow-up for all patients lasted until the study endpoint or until a patient's death. Data were analysed retrospectively using IBM SPSS statistical package 26 for Windows.

Results: The mean age was similar between the 2 groups, with the majority of patients in both being Caucasian. More than half of the males had complicated TBAD, while the majority of females were classed as having uncomplicated disease. The most commonly utilized proximal and distal landing zone for the TEVAR stent graft was zone 2 and zone 4, respectively. The mean proximal stent diameter was significantly larger in males compared to females (P = 0.004). The difference in mean distal diameter between the 2 groups was insignificant (P = 0.721). The mean total stent coverage of the thoracic aorta was 251.3 mm in male patients compared to 291.2 mm in females (P = 0.203). A total of 32 patients underwent adjunctive procedures. Seven (17%) of the males had one or more postoperative complications compared to 2 (12%) females. Nine (22%) males underwent a reintervention procedure post TEVAR compared to only 1 (6%) female (P = 0.136). Overall, males had a mortality rate of 24% (n = 10) compared to 41% of females (n = 7) (P = 0.201). Estimated survival of males and females post TEVAR was 80.4 ± 9.6 months and 69.7 ± 14.4 months (P = 0.428). For the total population, the number of stent grafts was inversely correlated with mortality.

Conclusions: Despite the favourable clinical outcomes achieved by TEVAR in TBAD, there remains a grey area concerning its management. Thus, it is important to perform risk stratification of individual patients using their demographics and comorbidities, particularly scrutinizing patient sex and ethnic origin, when considering intervention for TBAD to achieve optimum results.

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.avsg.2022.12.073DOI Listing

Publication Analysis

Top Keywords

tevar tbad
12
type aortic
8
aortic dissection
8
patients
8
thoracic endovascular
8
endovascular aortic
8
aortic repair
8
tevar
8
demographics disease
8
clinical outcomes
8

Similar Publications

Background: The aim of this study is to explore the value of different systemic inflammatory response indicators in the long-term prognosis of type B aortic dissection (TBAD) patients undergoing thoracic endovascular aortic repair (TEVAR).

Methods: This study retrospectively reviewed the case data of 540 patients with TBAD at our center from January 2013 to January 2019. Based on the occurrence of aorta-related adverse events (ARAEs) during follow-up, patients were divided into two groups: the ARAEs group and the non-ARAEs group.

View Article and Find Full Text PDF

Geometric Analysis of Aortic Arch for Patients with Type B Aortic Dissection.

Ann Vasc Surg

December 2024

Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, PR China. Electronic address:

Objectives: Endovascular management of aortic arch is always demanding and challenging in type B aortic dissection (TBAD) patients. However, there is limited knowledge to understand the complex geometry of aortic arch. The aim of this study is to investigate aortic arch geometry and its potential clinical implications for endovascular planning.

View Article and Find Full Text PDF

Background: Published reports demonstrate that the use of Castor stent-graft is a promising treatment of aortic pathologies with the need to land in zone 2. However, there is a lack of publications on the medium-term results of Castor in the European population. This research evaluates the mid-term results of the Castor stent-graft in several Polish centers for the treatment of aortic pathologies and enriches the current knowledge of Castor stent-grafts.

View Article and Find Full Text PDF

4D computed tomography assessment of ruptured triple-lumen type B aortic dissection: a case report.

Eur Heart J Case Rep

December 2024

Department of Cardiac Surgery, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400030, China.

Background: Few studies have investigated the effect of the intimal morphology of type B aortic dissection (TBAD) on the blood flow after rupture. We report a case of a 30-year-old male with complicated TBAD, who underwent assessment with 4D computed tomography (4D-CT).

Case Summary: Patient presented with chest tightness for 14 days, a heart rate of 67 b.

View Article and Find Full Text PDF
Article Synopsis
  • - The study evaluated the early and mid-term results of using a physician-modified candy-plug (pmCP) technique for occluding false lumen in patients with type-B aortic dissection, involving analysis of 17 patients treated between September 2018 and May 2024.
  • - Results showed a 100% technical success rate, an 82% clinical success rate, and a low postoperative mortality of 6%. Notably, 82% of patients achieved early complete false lumen occlusion.
  • - The pmCP technique demonstrated promising long-term outcomes with 75% of patients experiencing complete thoracic false lumen thrombosis and stable aneurysm sizes during follow-up, indicating reduced need for further aortic interventions. *
View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!