Background:

Chronic type B aortic dissection (cTBAD) is a rare but challenging condition that requires individual treatment strategies. This is mainly characterized by different considerations than in therapy of acute or subacute type B aortic dissection. Since thoracic endovascular aortic repair (TEVAR) is now recognized as standard of care for acute, complicated type B aortic dissection in patients with appropriate anatomy, the treatment approach for cTBAD is still challenging. In this study we investigated the follow-ups of patients with cTBAD and analyzed the time course of potential complications after TEVAR.

Methods:

In this single-center retrospective study we evaluated patients with cTBAD in our vascular outpatient clinic over the last 10 years. Follow-up consultations included contrast-enhanced, electrocardiogram-triggered, high-resolution (≤1.5mm slice thickness) CT angiography (CTA) (SOMATOM Siemens Healthineers, Forchheim, Germany). Continuous scans covered the entire aorta, including the proximal supra-aortic vessels down to the groin. Evaluated characteristics went beyond demographic characteristics combining the treatment approach (interventional vs. conservative) and the timing and occurrence of potential complications.

Results:

We analysed 133 patients in total (69.2% male, 30.8% female) with cTBAD with a mean follow-up of 67.7 months. Most of them underwent interventional treatment (n=102, 76.7%), of which the majority received TEVAR (n=82, 61.7%). A total of 80 patients (60.2%) had major complications after interventional treatment, whereas over a third was complication-free even after 5 years. Almost half of the complications occurred during the first year (n=38, 47.5%) and included mainly the necessity for stent elongation (n=10, 26.3%) and endoleaks related to the aortic prosthesis (n=7, 18.4%). The most common endoleak was type 1 (n=6) and required reintervention in all cases. 23 patients (17.3%) evolved complications within the time period 1 to 5 years. The most common complication in this time period was the development of FL or TL aneurysm (n=8), that needed reintervention in 7 cases.  

Conclusion:

The interventional treatment of cTBAD in terms of timing, therapy approach and indication is still challenging for the entire aortic team. That is precisely why complications after interventional treatment of cTBAD are still common. But the early recognition of occurring complications permits promising treatment options and highlights the importance of frequent follow-up examinations within the first years.