Thoracic endovascular aortic repair (TEVAR) carried out for uncomplicated type B aortic dissections (TBAD) saw worse mortality and aortic-related outcomes when performed in the acute phase compared to those treated in the subacute phase and those managed medically.
That was the chief conclusion of an investigation of TEVAR timing presented at the 2022 Eastern Vascular Society (EVS) annual meeting in Philadelphia (Sept. 29–Oct. 1) by Matthew Muller and colleagues from Albert Einstein College of Medicine in New York City.
Patients with acute uncomplicated TBAD between 2007 and 2019 were identified using the TriNetX Analytics Network, a federated network of nationwide healthcare organizations that provides de-identified patient data.
The study looked at 17,018 patients with TBAD, with 918 (5.4%) undergoing acute TEVAR, 328 (1.9%) subacute, and 15,772 (92.7%) being treated nonoperatively.
After 1:1 propensity matching, the research team found that the acute TEVAR group had higher rates of endovascular reintervention (7.76% vs. 1.09%; p<0.001) and aortic rupture at 30 days (3.93% vs. 1.09%; p<0.001) and three years (9.51% vs. 3.93%; p<0.001), when compared to medical management. The subacute group had significantly higher rates of endovascular intervention at three years when compared to medical management (9.17% vs. 3.06%; p=0.001). The rate of aortic rupture at three years was significantly higher in the acute TEVAR group compared to the subacute TEVAR group (10.2% vs. 3.51%; p=0.001). There were no significant differences in 30-day and three-year mortality rates, or three-year rates of open reintervention, between the three groups.
Muller told the EVS gathering that the acute TEVAR group was found to have higher rates of mortality compared to both the medical management and subacute TEVAR groups but this finding was not found to be statistically significant. Additionally, the subacute TEVAR group had lower three-year mortality rates compared to the medical management group, but this, too, was not found to be statistically significant.
“Our data shows that when TEVAR is performed in the subacute phase, there are lower rates of aortic rupture and mortality compared to medical management,” Muller concluded in his EVS 2022 presentation. “These are similar findings to previously discussed studies looking at the timing of TEVAR with regards to both complicated and uncomplicated type B aortic dissections.”