Emergency endovascular treatment of complicated type B acute aortic dissections: proximal repair without distal covering.

Background: Endovascular treatment is now the first choice for complicated type B dissections requiring surgery, but some authors claim that merely sealing the entry tear with Thoracic Endovascular Aortic Repair is not enough, advocating use of distal aortic stenting and ballooning. Objectives: This study aims to analyze 12 consecutive complicated type B acute aortic dissections to prove the safety and effectiveness of staged endovascular repair without distal ballooning or stenting. Methods: From January 2016 to September 2018, 15 cases of complicated type B dissections in need of emergency treatment (in less than 24 hours) were referred to our Unit. Endovascular repair was performed to cover the entry tear and the proximal tract of the false lumen, leaving its distal segment untouched. All patients were followed up with serial computed tomography angiography to assess the evolution of the false lumen. Results: Technical success was achieved in all cases. No peri-operative or post-operative deaths from any cause were reported over a mean follow-up of 28 months (range 12-45). False lumen thrombosis and regression > 5mm were observed in 11 cases. One patient underwent endovascular reintervention after 10 months because of expansion of the false lumen. No procedure-related complication was recorded. Conclusions: Staged endovascular repair is, in most cases, a feasible and safe technique for treatment of acute aortic dissections in emergency settings, with low morbidity/mortality rates and low risk of reintervention. Randomized clinical trials will be needed to establish an outcome-based comparison with new techniques such as PETTICOAT and STABILISE.