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TEVAR confers better long-term survival vs. medical therapy in uncomplicated type B aortic dissection

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HOLLYWOOD, Fla. — After 11 years of follow-up, patients with uncomplicated type B acute aortic dissection who had thoracic endovascular aortic repair had better survival rates than patients managed with optimal medical therapy, according to findings presented at the International Symposium on Endovascular Therapy (ISET).

While TEVAR is recognized as the first choice for complicated type B acute aortic dissection, there is controversy as to whether it should be preferred over optimal medical therapy for uncomplicated type B acute aortic dissection, Gao-Jun Teng, MD, FSIR, chair of the department of interventional radiology and vascular surgery and president of Zhongda Hospital, Southeast University, Nanjing, China, said.

The INSTEAD trial found no difference between TEVAR and optimal medical therapy for death, reintervention or adverse events, but it included patients with acute or chronic uncomplicated type B aortic dissection, he said.

ADSORB, the first prospective randomized controlled trial on this topic, showed no differences between the treatments in survival, but the sample size was small and follow-up was only 1 year, he said.

Teng and colleagues conducted a retrospective study comparing TEVAR plus antihypertensive medications (n = 184) vs. optimal medical therapy (n = 154) in patients with uncomplicated type B acute aortic dissection only, without rupture, malperfusion syndromes, refractory pain or rapid aortic expansion at onset or during hospitalization.

Outcomes of interest were all-cause mortality and aortic-related mortality.

The researchers published 5-year results in 2016 which favored the TEVAR group. Teng presented 11-year results here.

At 11 years, TEVAR plus antihypertensive medications was associated with a lower rate of all-cause death (log-rank P = .01) and aortic-related and unknown death (log-rank P = .012), Teng said.

The TEVAR group also had a lower rate of adverse events plus all-cause mortality (log-rank P = .006).

Early (less than 30 days) mortality and aortic-related events did not differ between the groups.

Between 30 days and 11 years, the TEVAR group had fewer aortic-related events (23.9% vs. 38.3%; P = .005) and fewer deaths (10.2% vs. 20.1%; P = .03), according to the researchers.

“The TEVAR procedure did not increase early major complications compared to best medical therapy,” Teng said. “Patients in the best medical therapy group experienced more aortic-related adverse events than those treated with TEVAR. Given that the TEVAR procedure could not significantly lower the morbidity and mortality during the early phase, TEVAR should be considered in patients with longer life expectancy.” – by Erik Swain

References:

Teng GJ. Session 4: Aortic Dissection and Complex TEVAR and TAVR. Presented at: the International Symposium on Endovascular Therapy (ISET); Feb. 3-7, 2018; Hollywood, Fla.

Brunkwall J, et al. Eur J Vasc Endovasc Surg. 2013;10.1016/j.ejvs.2014.05.012.

Nienaber CA, et al. Circulation. 2009:doi:10.1161/CIRCULATIONAHA.109.886408.

Qin YL, et al. J Am Coll Cardiol. 2016;doi:10.1016/j.jacc.2016.03.578.

Disclosure: Teng reports no relevant financial disclosures.