Original title: The results of stent graft versus medication therapy for chronic type B dissection Reference: Xin Jia et al. J Vasc Surg 2013;57:406-14
In many institutions patients with Chronic Stanford Type B Aortic Dissection is most often treated medically, and the thoracic endovascular aortic repair implant TEVAR or the surgical procedure are reserved for those who evolve with complications (persistent pain, expansion of false lumen, visceral or peripheral ischemia).
Even though these complications may not present, the prognosis for these patients continues to be around 30% mortality at 2 years. This prospective study included 303 consecutive patients with chronic type B aortic dissection that received, following medical criteria, optimal medical therapy (OMT) (95 patients) or thoracic endovascular aorta repair (TEVAR) (208 patients). There were no significant differences in baseline characteristics between the two groups. The median time between dissection and endoprosthesis was 23 days.
No deaths occurred during index hospitalization in the two groups. The TEVAR group 2 patients (0,9%) required emergency surgery for retrograde type A dissection, 6 patients (2,9%) had vascular complications, 2 patients (0,9%) presented neurological compromise and 2 patients (0,9%) periprocedural infarction. No patients in the OMT group presented events in 30 days.
Conclusion
This multicenter, prospective and not randomized study, showed lower mortality with TEVAR in treating chronic type B aortic dissection vs. OMT. However, global mortality showed no differences.
Editorial comment
Follow up was lost in more than 20% of patients in both groups but especially in the OMT group (as expected). This makes it difficult to interpret results at long term, precisely when benefits of precocious intervention should be seen. Beyond this limitation, this study shows a very acceptable complications rate at 30 days with the intervention, which raises questions about the efficiency of the traditional management of these patients.
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