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Treatment of Uncomplicated Type B Aortic Dissections is Safe During the Acute Presentation
Tareq M. Massimi, Michael C. Siah, Hyein Kim, Steven D. Abramowitz, Rajesh K. Malik, Misaki M. Kiguchi, Christian Shults, Edward Y. Woo.
Medstar Health, Washington, DC, USA.

Objective(s):
Thoracic Endovascular Aortic Repair (TEVAR) in Uncomplicated Type B aortic dissection (uTBAD) demonstrates benefit for prevention of future aortic degeneration and aneurysm-related mortality. Timing of treatment, however, is unclear. We demonstrate that treatment within the acute window can be performed with minimal morbidity and mortality. Methods:
A retrospective review of a prospectively maintained database of Type B Aortic Dissections (TBAD) at a single tertiary center was queried. We identified patients between 2014 and 2016, when treatment of uncomplicated dissections became more prevalent. We excluded patients who had TEVAR for complicated TBAD. Results:
Over the study period, 25 patients underwent TEVAR for acute uTBAD. Mean age was 65.5 years (95%CI 60.8-70.2) with 60% female, Mean time to intervention was 5.9 days (95%CI 4-7.8). Maximal aortic diameter was a mean of 41.9mm (95%CI 39.5-44.4) with an average maximal false lumen diameter of 19.9mm (95%CI16.6-23.2) in the upper thoracic aorta and average minimal true lumen diameter of 16.2mm (95%CI 12.7-19.7). Zone 2 coverage was required in 68%, all of which had preemptive left subclavian revascularization. On average, 271mm (95%CI 245-297) of the aorta was covered. Average blood loss was 167 ml (95%CI 110-225). There were no 30-day aneurysm related or all-cause mortalities[E1] [TM2] . There were no cases of spinal cord ischemia or permanent renal failure[E3] . One patient (4%) developed a stroke that was recovered on third month follow up. One patient (4%) developed respiratory failure which resolved after thoracentesis. Average Length of stay was 14.8 days (95%CI 11.3-18.2). Average post-operative follow up was 7.5 months (CI 4.1-11). Conclusions:
In patients treated for uTBAD, it is safe to proceed with treatment during the acute window. In today's age of decreasing length of stay and poor patient follow-up, treatment within the first few days of presentation may be necessary.


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