Distal Extent of Aortic Dissection Increases Risk of Malperfusion Syndromes and Need for Reoperation in Patients with Acute Type B Aortic Dissection.

BACKGROUND: Aortic morphology is an important consideration in patients who present with acute type B aortic dissection (TBAD). This study evaluates the relationship between the distal extent of dissection with malperfusion syndromes, clinical outcomes after thoracic endovascular aortic repair (TEVAR) and mortality.

METHODS: The Vascular Quality Initiative (VQI) database was queried from 2012 to 2022 for patients undergoing TEVAR for acute TBAD. Primary exposure variable was distal extent of dissection, categorized as thoracic (zones 2-5), abdominal (zones 6-9) or iliac (zones 10-11). Primary endpoints were 30-day and 2-year mortality. Secondary endpoints included postoperative malperfusion, resolution of malperfusion following TEVAR, and reoperation. Outcomes were compared between cohorts.

RESULTS: 2,455 patients were included. A more distal extent of dissection was associated with a stepwise increase in risk of lower extremity (5.8% vs. 8.7% vs. 27.4%), intestinal (5.1% vs. 13.6% vs. 19.8%) and renal (6.7% vs. 17.7% vs. 27.3%) ischemia on presentation (P < 0.0001 for all). Distal extent of dissection was associated with increased rates of postoperative mesenteric (2.4% vs. 4.6% vs. 6.1%, P = 0.0009) and renal (2.7% vs. 5.5% vs. 6.0%, P = 0.0036) ischemia, and increased rates of reoperation (11.3% vs. 15.0% vs. 17.3%, P = 0.0017). Distal extent of dissection was not associated with resolution of malperfusion after TEVAR, and not independently associated with 30-day or 2-year mortality (P > 0.05 for all).

CONCLUSION: Although a more distal extent of aortic dissection is associated with increased rates malperfusion on presentation and increased rates of complications after TEVAR, it is not independently associated with mortality.