Endovascular treatment of retrograde type A aortic dissection: a decade of experience in a single-center

TL;DR

This study shows that endovascular repair is a safe and effective treatment for aortic dissection patients over a decade of clinical experience.

Contribution

The study provides long-term outcomes and identifies optimal stent placement for treating retrograde type A aortic dissection.

Findings

TEVAR had a 98.7% technical success rate and low mortality rates in RTAD patients.

89.7% of patients showed positive ascending aortic remodeling during follow-up.

One patient developed an isolated ascending aorta dissection but remained alive without treatment.

Abstract

This study aims to evaluate the long-term outcomes of thoracic endovascular aortic repair (TEVAR) in patients with acute or subacute retrograde type A aortic dissection (RTAD). Additionally, it sought to identify the appropriate intraoperative stent landing zone and the optimal stent size.

A retrospective analysis was conducted on patients with acute/subacute RTAD who received TEVAR treatment at our hospital from January 1, 2013, to December 31, 2023. The aortic diameter was measured using the IFINIT imaging computing platform. Patient characteristics, surgical details, hospitalization, follow-up data, and aortic remodeling were analyzed. The stent landing zone and stent size were determined based on preoperative computed tomography angiography (CTA) images and intraoperative digital subtraction angiography (DSA), and were further verified through aortic remodeling results.

A total of 78 patients were included, all of whom were admitted during the acute or subacute phase. In-hospital mortality and 30-day mortality rates were both 6.4%. The 30-day complication rate was 11.5%. The overall technical success rate was 98.7%. With a median follow-up time of 41 months (interquartile range 25.5–71.5 months), the overall cumulative survival rate were 91.7% (95% CI: 85.2%–98.2%) at 1 and 3 years, and 89.3% (95% CI: 81.5%–97.1%) at 5 years. One of the 78 patients developed an isolated ascending aorta dissection 6 months after surgery; this patient remains alive without treatment. During follow-up, positive ascending aortic remodeling was observed in 89.7% of patients.

TEVAR appears to be a safe, effective, and durable treatment option for carefully selected patients with acute or subacute RTAD. Simultaneously, thorough screening is essential for patients presenting with dissection in the acute phase.

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