Role of Thoracic Endovascular Aortic Repair in Aortic Dissections – Factors Affecting Outcome

Abstract

Background: Thoracic endovascular aortic repair (TEVAR) is increasingly employed in managing both residual type A and type B aortic dissections. This study aimed to evaluate short- and midterm outcomes following TEVAR and identify factors influencing technical success, complications, and reintervention across different healthcare systems.

Methods: A dual-centre observational study was conducted on consecutive patients with aortic dissection who were treated with TEVAR between October 2022 and September 2024 at two institutions: Mansoura University ‘MU’ (Mansoura, Egypt) and Ludwig Maximilian University ‘LMU’ Hospital (München, Germany). Patients with residual type A and acute, subacute, or chronic type B dissections were included. The primary endpoints were technical success, 30-day mortality and reintervention. The secondary endpoints were aortic remodeling, follow-up survival, and freedom from reintervention.

Results: Fifty-two patients were included, with 42 males (80.8%) and a mean age of 62.7 ± 10.5 y. Technical success was achieved in 51 patients (98.1%), with 30-day reintervention and mortality rates of 7.7% and 3.8%, respectively. The follow-up period (13.8 ± 7.2 m) recorded 9 reinterventions and 5 mortalities. Positive remodeling was achieved in 73.1% of the patients. Kaplan–Meier estimates at 12 months showed overall and aortic-related survival of 95.4% and 100%, and freedom from overall and aortic-related reintervention at 84.8% and 86.9%, respectively.

Conclusion: TEVAR is effective in achieving favorable short- and midterm outcomes in aortic dissection across healthcare systems. Complicated dissections, higher BMI, and clinical malperfusion were associated with worse early outcomes. Persistent false lumen perfusion at discharge predicted follow-up mortality, whereas additional intraoperative procedures reduced late aortic reinterventions.