Endovascular Repair for Type B Aortic Dissection Accompanied by Retrograde Intramural Haematoma

Abstract Objectives To demonstrate the outcome of thoracic endovascular aortic repair (TEVAR) for patients with type B aortic dissection (TBAD) accompanying retrograde intramural haematoma (RTIMH) in zone 0-2. Methods Patients were registered in a retrospective multicentre study and divided into 2 groups: presence of RTIMH involving zone 0-2 (group 1) and RTIMH confined to zones 1 and 2 not involving zone 0 (group 2). The primary end-point was any adverse aortic event (AAE), including the development of full dissection in the ascending aorta, aorta-related mortality, reintervention, and procedure-related complications. Results A total of 155 patients were enrolled, with 68 (43.9%) in group 1 and 87 (56.1%) in group 2. The AAEs occurred in 14 (9.0%) patients, with 8 in group 1 and 6 in group 2, and no significant differences were found between the 2 groups (P = .294). Patients in group 1 were younger (50.1 ± 6.5 vs 55.6 ± 9.2, P = .04) and more often had a primary entry at the inner curvature of the arch (57.4% vs 25.3%, P < .001). In group 1, freedom from reintervention was significantly lower than in group 2 with 79.1% in group 1 and 93.3% in group 2 (P = .02). Conclusions In selected cases, TEVAR is an effective alternative treatment modality to open repair for TBAD with RTIMH extending to zone 0. However, the rate of reintervention is higher in those with RTIMH propagation into the proximal ascending aorta, suggesting closer follow-up. Clinical registration number This retrospective multicenter analysis registered as a Chinese Clinical Trial (ChiCTR2300071443).