Comparison of endovascular therapy to medical therapy in the management of aortic dissection

BACKGROUND: This study compares outcomes in patients with aortic dissections (ADs), with and without organ malperfusion, managed with TEVAR, TEVAR plus stenting of side-branches (TEVAR+) and best medical therapy (BMT). METHODS: Thirty-five patients with Stanford B AD were divided into three groups based on their dissection management: TEVAR (N.=11), TEVAR+ (N.=8) and BMT (N.=16). RESULTS: TEVAR+ patients spent 22 days hospitalized, compared to 12 for BMT and 7 for TEVAR patients (P=0.05). Younger age was found to be a predictor of a longer hospitalization (P=0.008). TEVAR+ patients exhibited the highest average systolic pressures upon presentation of 209, compared to 167.9 for BMT and 168.8 for TEVAR patients (P=0.025). Four BMT patients (25%) required future TEVAR. CONCLUSIONS: Patients with dissections that necessitated branch stenting were younger, presented with higher systolic pressures and had longer hospital stays compared to patients managed with TEVAR alone or BMT.