Introduction: This retrospective review aimed to compare clinical outcomes between patients with descending aortic dissections, with and without organ malperfusion, who were managed with thoracic endovascular aortic repair (TEVAR) or best medical therapy (BMT).
Methods: Thirty-eight patients diagnosed with descending aortic dissections between 2013 and 2020 were identified for analysis. Patients with dissection secondary to trauma and death unrelated to cardiothoracic pathology were excluded. Participants were divided into three groups based on their management: TEVAR (without side branch stenting), TEVAR+ (with additional branch stenting) and BMT. The primary outcome measure was length of hospital stay (LOS) and statistics were analyzed using ANOVA.
Results: There was a significant difference in the LOS between the three groups (p=0.005), with TEVAR+ patients spending an average of three weeks in the hospital, compared to twelve days for patients managed with BMT and seven days for TEVAR patients. Younger age at presentation was a significant predictor of a longer LOS (p=0.008). Systolic blood pressure was significantly different (p=0.025), with TEVAR+ patients having the highest average pressures of 201, followed by TEVAR patients of 168 and BMT patients of 167. Initial diagnosis of aortic dissection with concomitant organ malperfusion (TEVAR+) was a significant predictor of LOS (p= 0.008).
Discussion: TEVAR+ patients were younger, had higher systolic blood pressures and stayed significantly longer in the hospital compared to patients managed with TEVAR alone or BMT. Future studies should focus on the most efficacious treatment for this patient population who suffer from the highest morbidity amongst dissection patients.
Cehelyk, Eli and Abai, MD, Babak, "Comparison of endovascular therapy versus medical therapy in the management of descending thoracic aortic dissection" (2021). Phase 1. Paper 73.