The natural history of medically managed acute type B aortic dissection

Durham, Christopher A.; Cambria, Richard P.; Wang, Linda J.; Ergül, Emel; Aranson, Nathan J.; Patel, Virendra I.; Conrad, Mark F.

doi:10.1016/j.jvs.2014.12.038

Cited by 169 publications

(108 citation statements)

References 31 publications

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“…In our study, the early event rate in the TEVAR group was 10.3%, which was higher than that of the BMT group (4.5%), although the difference was not statistically significant. The early event rate in the BMT group was consistent with findings from previous studies (19,20 In previous studies, the early mortality rates in patients with type B aortic dissection treated with TEVAR range between 2.4% and 10.9% (8,14) and, in patients treated with BMT, the range has been between 0% and 10.6% (5,11,21,22 CTA imaging in this study. Consistent with an earlier report (23), SINE was a severe complication in the TEVAR group and was associated with substantial mortality The patients in the BMT group experienced more aortic-related adverse events than those treated with TEVAR (Figure 1), and this result was partially consistent with our earlier report (11).…”

Section: Resultssupporting

confidence: 91%

Endovascular Repair Compared With Medical Management of Patients With Uncomplicated Type B Acute Aortic Dissection

Qin

Wang

et al. 2016

Journal of the American College of Cardiology

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Section: Resultssupporting

confidence: 91%

Endovascular Repair Compared With Medical Management of Patients With Uncomplicated Type B Acute Aortic Dissection

Qin

Wang

et al. 2016

Journal of the American College of Cardiology

113

134

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“…We previously showed that the 6-year intervention-free survival of patients with acute type B dissection treated with medical therapy alone is 40%. 11 Accordingly, many patients may benefit from early thoracic stent grafting. However, criteria to determine appropriate patient selection and the exact timing of the early intervention remain unknown.…”

Section: Discussionmentioning

confidence: 99%

“…5,[7][8][9][10] We recently showed in a contemporary series of patients that aneurysmal degeneration of the aorta has been relatively unaltered by current medical therapy, because only 41% of patients demonstrated an intervention-free survival after 6 years. 11 However, there are limited contemporary data regarding the rate of aortic expansion while patients are being managed with optimal medical therapy, and there is a paucity of data regarding which factors might be predictive of aortic growth. The goal of this study was to evaluate the rate of aneurysmal degeneration in a contemporary series of patients with acute type B aortic dissection who were initially treated with medical therapy alone and to identify factors associated with aortic growth.…”

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confidence: 99%

Aneurysmal degeneration of the thoracoabdominal aorta after medical management of type B aortic dissections

Durham

Aranson

Ergül

et al. 2015

Journal of Vascular Surgery

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“…Up to 40% of patients reportedly undergo surgery after BMT, resulting in a relatively low overall 6-year interventionfree survival rate approximating 41% (5-7). Furthermore, the reported 3-, 5-, and 6-year mortality rates are also suboptimal at 22.4%, 27.9%, and 42%, respectively (7)(8)(9).…”

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confidence: 96%

Treatment of uncomplicated acute type B aortic dissection in the endovascular era: is it time for a paradigm shift?

Choo

2017

J. Thorac. Dis.

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Qin et al.(1) reported a multi-institutional retrospective study involving three hospitals that analyzed and compared the effects of thoracic endovascular aortic repair (TEVAR) combined with best medical treatment (BMT) versus BMT alone for treating uncomplicated acute type B aortic dissection (TBAD). The controversy regarding the actual efficacy and benefits of TEVAR in uncomplicated acute TBAD is partly attributable to study reports based on analysis over a heterogeneous population of both complicated and uncomplicated TBAD patients (2). To address this issue, Qin et al. selectively included patients diagnosed with uncomplicated acute TBAD only. The results clearly showed a greater benefit of adding TEVAR to BMT over BMT alone. Currently, TEVAR is a class II recommendation for treating uncomplicated acute TBAD, while BMT remains a class I recommendation (3,4). The lower class of recommendation for TEVAR is mostly attributable to the lack of robust data to support its routine application. Currently, BMT appears to demonstrate relatively enhanced short-term outcomes. However, the early benefits do not seem to be sustained over time, as evidenced by the time-dependent occurrence of aneurysmal degeneration and rupture or disease progression. Up to 40% of patients reportedly undergo surgery after BMT, resulting in a relatively low overall 6-year interventionfree survival rate approximating 41% (5-7). Furthermore, the reported 3-, 5-, and 6-year mortality rates are also suboptimal at 22.4%, 27.9%, and 42%, respectively (7-9).In contrast to uncomplicated TBAD, TEVAR is a class I recommendation for complicated acute TBAD (3,4). Considering the relatively poor long-term outcomes of BMT alone and the encouraging results observed with TEVAR for complicated acute TBAD, it seems reasonable to expect improved outcomes with TEVAR added to BMT for this condition. The ADSORB trial was the only prospective, randomized clinical trial aimed at collecting level A evidence for treating uncomplicated acute TBAD with TEVAR (10). Although the 1-year analysis was too short to address some of the more long-term issues, and the relatively small cohort size was limiting for an adequate statistical power of analysis, the procedural safety and significantly enhanced outcomes in terms of greater, albeit incomplete, false lumen (FL) thrombosis, decrease in FL size, and increase in true lumen (TL) size supported adding TEVAR to BMT (10). Similar to the ADSORB trial, Qin et al.(1) conducted a multi-institutional but a retrospective study. Despite its limitations, the study involved a larger cohort of 338 patients in which 184 received TEVAR plus BMT and 154 received BMT alone. Furthermore, the follow-up duration was significantly longer at 11 years. Therefore, the major strengths of this study were in the greater statistical power of analysis and the ability to provide valuable information regarding the primary endpoints over a significantly longer period of time. In this study, BMT plus TEVAR showed significantly fewer overall all-cause aorta-...

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The natural history of medically managed acute type B aortic dissection

Cited by 169 publications

References 31 publications

Endovascular Repair Compared With Medical Management of Patients With Uncomplicated Type B Acute Aortic Dissection

Endovascular Repair Compared With Medical Management of Patients With Uncomplicated Type B Acute Aortic Dissection

Aneurysmal degeneration of the thoracoabdominal aorta after medical management of type B aortic dissections

Treatment of uncomplicated acute type B aortic dissection in the endovascular era: is it time for a paradigm shift?

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