Endovascular Management of Type B Aortic Dissection by Cardiothoracic Surgeons

Purpose: Surgery of the thoracic aorta leads to high mortality and morbidity rates. The endovascular technique has enjoyed greater permissiveness for the treatment of penetrating ulcer, intramural hematoma, traumatism of the aorta, dissections. Minimally invasive surgery has enough evolved nowadays. Endovascular management for Stanford type B is amenable to be performed by this way by cardiothoracic surgeons. We sought to showcase our initial surgical experience in this kind of pathology at our institution.

Materials and Methods: This is a retrospective, observational study gathering all comers with primary diagnosis as aortic dissection Stanford type B, DeBakey type IIIa, at our institution from January 2017 through January 2019. Eighteen patients underwent any aortic endovascular procedure, with just 12 being involved beyond (distal) the branching off the left subclavian artery, 18 patients underwent an aortic endovascular procedure, and 12 had a compromise after the emergence of the left subclavian artery.

Results: From January 2017 to January 2019, 18 patients underwent endovascular procedures through a femoral or iliac arterial approach with a commercially available device. Six cases undergoing other aortic arch surgical procedure else were ruled out. Mean age was 57 years, ranging from 32 to 80 years. A right femoral approach was used in 7 cases, and a right iliac artery approach was used in 5. Seventy-five percent of patients required one endoprosthesis release. Surgical time was 170 minutes in average. Length of intensive care unit stay was 2 days. In-hospital stay was 5 days. Among complications, there were one case of cerebral edema coming from the femoral approach and another with endoleak type II coming from the iliac approach (P = 0.25). The operative mortality rate (1 month) and at 1-year follow-up was 0%.

Conclusions: The endovascular approach has led to major changes in therapeutic possibilities affecting the thoracic aorta, with shorter hospital stays and lower rates of complications and mortality in relation to conventional surgery. Cardiothoracic surgeons with a good learning curve are able to deal with this type of pathology aortic with promising results and before any complication will be able to effect resolution.