Outcomes of Patients With Acute Type B (DeBakey III) Aortic Dissection

C urrently, acute aortic dissection remains the most common aortic catastrophe, 1–3 with management and prognosis determined by location of the affected aortic segment. Acute aortic dissection involving the ascending aorta, Stanford type A or DeBakey type I or II, is treated with urgent surgical intervention, whereas acute aortic dissection involving the descending thoracic aorta or thoracoabdominal aorta (Stanford type B or DeBakey type III) is managed medically or by surgical or endovascular intervention when complicated. 4 Over the past decade in the United States, the management of acute type B aortic dissection (ATBAD) has evolved from primary initial medical management to endovascular intervention , especially for complicated presentation. 5 Patients with complicated (c) ATBAD treated with thoracic endovascular aortic repair (TEVAR) had improved outcomes compared with patients treated with open aortic repair. 6–8 However, the treatment of uncomplicated (u) ATBAD remains controversial. Much controversy has arisen as the result of recent evidence demonstrating beneficial midterm outcomes from endovascu-lar treatment of uATBAD. This mounting evidence recently led the US Food and Drug Administration to expand the indications of thoracic endovascular stent grafts to include all disorders of the thoracic aorta, including the treatment of all type B aortic dissections, despite few long-term data on patients with cATBAD and no data on uATBAD. In 2006, we reported our experience with the management of ATBAD before our adoption of endovascular techniques for aortic dissection. 12 In that report, we primarily managed Background—Aortic dissection remains the most common aortic catastrophe. In the endovascular era, the management of acute type B aortic dissection (ATBAD) is undergoing dramatic changes. The aim of this study is to evaluate the long-term outcomes of patients with ATBAD who were treated at our center over a 13-year period. Methods and Results—We reviewed patients with ATBAD between 2001 and 2014, analyzing variables based on status (complicated [c] versus uncomplicated [u]) and treatment modalities. We defined cATBAD as rupture, expansion of diameter on imaging during the admission, persistent pain, or clinical malperfusion leading to a deficit in cerebral, spinal, visceral, renal, or peripheral vascular territories at presentation or during initial hospitalization. Postoperative outcomes were defined as deficits not present before the intervention. Outcomes were compared between the groups by use of Kaplan-Meier and descriptive statistics. We treated 442 patients with ATBAD. Of those 442, 60.6% had uATBAD and were treated medically, and 39.4% had cATBAD, of whom 39.0% were treated medically …