Objective

The optimal treatment for patients with aneurysmal disease following chronic type B dissection (CTBD) involving the descending thoracic (DTA) or thoracoabdominal aorta (TAAA) remains a matter of debate. We reviewed our experience of open (OR) and endovascular repair (ER) in this cohort of patients.

Methods

We interrogated our prospectively maintained database to identify consecutive patients who underwent OR or ER of CTBD aneurysms of the DTA and TAAA between 1998 and 2014. Eighty-four patients (median age 55, range 23-88, years) underwent OR (n=61; DTA 20, TAAA 41) or ER (n=23; DTA with standard endografts: 17, TAAA with fenestrated/branched endografts: 5). Twenty-nine (34.5%) patients had connective tissue disease (CTD) and all were treated with OR.

Results

In-hospital mortality was 8.3% for the entire cohort, 0% and 12.2 % for OR of DTA and TAAA, respectively and 11.7% and 0% for ER of DTA and TAAA, respectively. Overall rate of permanent and temporary stroke and spinal cord injury (SCI) were 4.8%, 2.4% and 1.2%, respectively. In patients with CTD, there were no in-hospital deaths or neurological complications. A composite endpoint of in-hospital death, stroke, SCI and permanent dialysis at discharge occurred in 14.3%.

Conclusion

Open repair of CTBD aneurysms is the treatment of choice for patients with CTD and low-risk young patients with degenerative disease. In older, higher-risk patients with degenerative disease and those presenting as an emergency, ER may be associated with lower peri-procedural risk. Fenestrated/branched endografts have expanded the role of ER to higher-risk patients with TAAA. The best treatment option for the individual patient should be decided by a multidisciplinary team of aortic specialists.