Optimal medical treatment versus endovascular aortic repair in uncomplicated isolated abdominal aortic dissection

Sheng Su; Jitao Liu; Changjin Wang; Ruirong Chen; Yuan Liu; Wenhui Huang; Songyuan Luo; Fan Yang; Jianfang Luo

doi:10.1016/j.jvs.2022.10.036

Optimal medical treatment versus endovascular aortic repair in uncomplicated isolated abdominal aortic dissection

J Vasc Surg. 2023 Apr;77(4):1028-1036.e2. doi: 10.1016/j.jvs.2022.10.036. Epub 2022 Nov 1.

Authors

Sheng Su¹, Jitao Liu², Changjin Wang¹, Ruirong Chen³, Yuan Liu², Wenhui Huang², Songyuan Luo², Fan Yang⁴, Jianfang Luo⁵

Affiliations

¹ The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China; Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China.
² Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China.
³ The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
⁴ Department of Emergency and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
⁵ The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China; Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China. Electronic address: jianfangluo@sina.com.

PMID: 36332808
DOI: 10.1016/j.jvs.2022.10.036

Abstract

Objective: To report the results of optimal medical treatment (OMT) and endovascular aortic repair (EVAR) in patients with uncomplicated isolated abdominal aortic dissection (IAAD).

Methods: A retrospective review of 96 consecutive patients with uncomplicated IAAD (uIAAD) managed at a single tertiary vascular unit between January 2011 and July 2021 was conducted. Standard methods for univariate and survival analyses were used. The primary outcomes were all-cause mortality. Secondary end points included uIAAD progression, interventional complications, and follow-up aortic intervention.

Results: Initially, 53.1% of patients (51/96) were managed with OMT. No in-hospital deaths occurred. During follow-up, three patients died, and three and two patients who were initially managed with OMT subsequently required endovascular treatment and surgical management, respectively. Initially, 46.9% of patients (45/96) underwent EVAR. One patient died during hospital admission; nine patients had an endoleak after operation and one needed reintervention. Furthermore, during follow-up, five patients died; four patients needed reoperation, one surgery and three endovascular treatments. The overall long-term mortality was 8.4%, and follow-up aortic intervention rate was 9.5% (median follow-up, 54 months; interquartile range, 33-81 months) with no significant difference between groups. Of note, 12 patients (12.6%) suffered uIAAD progression, which was higher in the OMT group than EVAR group (10 [19.6%] vs 2 [4.5%]; P = .03).

Conclusions: uIAAD may be managed safely by OMT with regular surveillance, despite the risk of disease progression. Compared with OMT, EVAR could significantly prevent uIAAD progression. For anatomically suitable patients with uIAAD progression and who are unresponsive to OMT, pre-emptive EVAR is a safe and feasible option.

Keywords: Endovascular aortic repair; Optimal medical treatment; Outcomes; Uncomplicated isolated abdominal aortic dissection.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aortic Aneurysm, Abdominal* / diagnostic imaging
Aortic Aneurysm, Abdominal* / surgery
Aortic Dissection* / diagnostic imaging
Aortic Dissection* / surgery
Blood Vessel Prosthesis Implantation* / adverse effects
Dissection, Abdominal Aorta*
Endovascular Aneurysm Repair
Endovascular Procedures*
Humans
Postoperative Complications
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome