Journal Article

Real-world outcomes and management trends in uncomplicated type B aortic dissection

Sugawara, Akira, Nakatani, Eiji, Ueki, Chikara

2025

Overview

Uncomplicated type B aortic dissection (uTBAD) accounts for a significant proportion of TBAD cases, but large-scale data on their prognosis remain limited. This study aims to evaluate real-world management and outcomes of uTBAD. Patients aged 20 or older admitted for acute TBAD between 1 April 2013 and 30 September 2020 were included in the analysis set. They were classified as uTBAD 1 month after admission. Data were sourced from the Shizuoka Kokuho Database, a regional claims database. The primary outcomes were all-cause mortality and aortic events (death, type A dissection, rupture or surgery). Cumulative event rates were estimated using the Kaplan-Meier method. Outcomes of patients treated with thoracic endovascular aortic repair (TEVAR) versus medical therapy were compared using inverse probability weighting. A total of 1292 uTBAD patients were identified. Sixty-seven patients underwent TEVAR within 12 months, with a cumulative TEVAR rate of 5.4%. The cumulative mortality was significantly higher in comparison to the age- and sex-adjusted general population (1 year: 15.0% vs 6.7%, 3 years: 28.6% vs 18.6%, P < 0.001). Aortic events occurred in 22.1%, 30.0% and 36.7% at 1, 2 and 3 years, respectively. TEVAR within 12 months was associated with a trend towards lower mortality (adjusted hazard ratio 0.53, 95% confidence interval 0.27-1.04) and fewer aortic events (adjusted hazard ratio 0.54, 95% confidence interval 0.29-1.01) compared to medical therapy. uTBAD patients have poorer survival and higher rates of aortic events compared to the general population. TEVAR within 12 months can potentially improve patient outcomes.

• Publisher: Oxford Publishing Limited (England)
• Subject: Adult / Aged / Aortic Aneurysm, Thoracic - diagnostic imaging / Aortic Aneurysm, Thoracic - mortality / Aortic Aneurysm, Thoracic - surgery / Aortic Aneurysm, Thoracic - therapy / Aortic dissection / Aortic Dissection - diagnostic imaging / Aortic Dissection - mortality / Aortic Dissection - surgery / Aortic Dissection - therapy / Blood Vessel Prosthesis Implantation - adverse effects / Blood Vessel Prosthesis Implantation - mortality / Blood Vessel Prosthesis Implantation - trends / Databases, Factual / Endovascular Procedures - adverse effects / Endovascular Procedures - mortality / Endovascular Procedures - trends / Female / Humans / Male / Medical prognosis / Middle Aged / Mortality / Retrospective Studies / Risk Assessment / Risk Factors / Time Factors / Treatment Outcome