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Evidence summaries

Endovascular Versus Conventional Medical Treatment for Uncomplicated Chronic Type B Aortic Dissection

Prophylactic or early stenting in patients with uncomplicated chronic type B aortic dissection may not have any survival benefits at 2 years compared to best medical treatment with close surveillance. Level of evidence: "C"

The quality of evidence is downgraded by imprecise results (few patients and outcome events) and indirectnessd (only short-term outcomes reported).

Summary

A Cochrane review [Abstract] 1 included 1 study with 140 subjects. This multi-centre trial enrolled patients with stable type B aortic dissection after 14 days of the index type B aortic dissection. Those who had traditional indications for endovascular or open surgery (diameter 6 cm) or acute complications were excluded. Patients were randomised to either optimal medical therapy (OMT) only, including tight blood pressure control, close surveillance and recurrent computed tomography imaging, or to elective stent-graft placement plus optimal medical therapy (OMT + TEVAR).

All-cause mortality (OMT+TEVAR 7/72 vs. OMT 4/68; RR 1.65, 95% CI 0.51 to 5.39) or aorta-related deaths (OMT+TEVAR 4/72 vs. OMT 2/68; RR 1.89, 95% CI 0.36 to 9.98) were not statistically significantly different between study groups during 2 years follow-up. Of the 68 patients initially randomised to the OMT group, 11 patients (16.2%) crossed over to the OMT + TEVAR group with uneventful outcomes; 3 patients (4.4%) required open surgery during the study follow-up period.A total of 91.3% of patients in the TEVAR group showed aortic remodeling with true aortic lumen recovery and false lumen thrombosis compared with only 19.4% in the OMT group, including crossovers (P < 0.001).

Clinical comments

Data on the anatomic remodeling of dissected aortas observed after TEVAR is encouraging and future studies should follow-up subjects for at least 5 years to see if early endovascular interventions, even in stable initially uncomplicated type B patients, are of long-term benefit.

Note

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    References

    • Ulug P, McCaslin JE, Stansby G et al. Endovascular versus conventional medical treatment for uncomplicated chronic type B aortic dissection. Cochrane Database Syst Rev 2012;(11):CD006512. [PubMed]

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