Long-term Results of Endovascular Treatment of Chronic Type B Aortic Dissection by Closure of the Primary Tear

Background: The role of thoracic endovascular aortic repair (TEVAR) in the treatment of chronic type B aortic dissection is controversial. Some advocate open surgery, based on the premise that all tears must be treated, and others prefer branched endografts with the same premise. However, TEVAR, with closure of the primary tear in the thorax, has shown good results in some centers. This single-center cohort study was designed to contribute to the knowledge of the long-term evolution (mean, 4.8 years) of the patients submitted to endovascular closure of the proximal intimal tear. Methods: A total of 36 patients with asymptomatic chronic aortic dissection had a successful closure of the primary tear by TEVAR and were followed up for a median time of 57.2 months. Results: In 75% of the cases, there was stabilization or decrease in the maximum diameter. Twenty-five percent had diameter increase in the thoracic or abdominal aorta and indication for one or more additional procedures. One patient refused a second procedure and died from rupture one month after the last evaluation; this was the only case of rupture in the series. One patient died of unrelated cause before having been submitted to a second procedure. Thirty-four patients survived without diameter increase in the follow-up period. Conclusions: Chronic type B aortic dissections can be successfully treated by the coverage of the proximal tear with an endograft. Patients shall be followed carefully, and 25% of them will require one or more additional procedures to achieve a good result.