Complications after treatment of type B aortic dissection with TEVAR stent-graft deployment in zone 2

Abstract

Objective

To analyze the outcome of 147 cases of type B aortic dissection with thoracic endovascular aortic repair (TEVAR).

Methods

We systematically reviewed 147 patients of type B aortic dissection with stent graft deployment in zone 2 or zone 3 by TEVAR from January 2012 to December 2022. These patients were observed by computed tomography angiography after the first and third months and annually thereafter during follow-up. Statistical analysis was performed by SPSS.16.

Results

The stent graft of 107 patients was deployed in zone 3, and the stent graft of 40 patients was deployed in zone 2. Severe dissection and surgery-related complications after TEVAR occurred in 19 patients, with complications arising more frequently in zone 2 than in zone 3 (12/40 vs. 7/107, P < 0.005). Endoleak was detected in 10 (6.8%, 10/147) cases, which included 6 cases of endoleak in zone 2, exceeding the 4 cases of endoleak in zone 3 (6/40 vs. 4/107, P < 0.05). Twelve (8.16%, 12/147) cases underwent re-intervention, and the 8 patients who underwent re-intervention in zone 2 exceeded the 4 patients who underwent re-intervention in zone 3 (8/40 vs. 4/107, P < 0.05). One case of subclavian steal in zone 2 (0.68%, 1/147). Two (1.36%, 2/147) cases died after TEVAR. The 1-year, 3-year, and 5-year overall survival rates were 99.3%, 98.6%, and 98.6%, respectively. The re-intervention rates were 5.4%, 7.5%, and 8.2%, respectively. The re-intervention rates in zone 2 were 15%, 20%, and 20%, respectively. The re-intervention rates in zone 3 were 1.9%, 2.8%, and 3.7%, respectively.

Conclusion

TEVAR is the major treatment to use if the stent graft can be deployed in zone 3. However, with the higher rate of complications and re-intervention after TEVAR, for patients whose stent graft can only be deployed in zone 2, it is not recommended that TEVAR be chosen as the preferred treatment.