LAUSR

OBJECTIVE Thoracic endovascular aortic repair (TEVAR) has been shown to effectively treat malperfusion associated with acute type B thoracic aortic dissections (TBAD). A subset of patients may still require adjunctive peripheral or visceral artery branch interventions at the time of TEVAR to remedy persistent end organ malperfusion. Our objectives were to determine the incidence of these adjunctive interventions and to compare outcomes between patients who did and did not undergo them. METHODS Retrospective review of the TEVAR and complex EVAR module of the Vascular Quality Initiative (VQI) from 2010 to 2019, identifying all patients treated for malperfusion due to an acute TBAD. The anatomic branch and procedure performed at the time of TEVAR was recorded. Thirty-day mortality, need for re-intervention, complication rates, and overall survival was compared between patients by adjunctive intervention status. RESULTS A total of 426 patients underwent TEVAR for acute TBAD with end organ malperfusion. Among this cohort, 126 patients (29.6%) underwent 182 adjunctive branch interventions at the time of TEVAR. The most common interventions were stenting (n = 86, 47.3%) and stent grafting (n = 49, 26.9%), with the most common site being the left renal artery (n = 49, 26.9%). Patients undergoing TEVAR had similar thirty-day mortality (12.4% with branch intervention vs 15.6% without, p = .511) and rates of in-hospital re-intervention (19.2% with branch intervention vs 20.7% without, p = .732) by branch intervention status. There were no differences in the rates of postoperative complications and overall survival at 3 years between patients with adjunctive branch procedures compared to patients without. CONCLUSIONS Adjunctive peripheral and visceral artery branch interventions at the time of TEVAR for acute TBAD with malperfusion occurred in a third of index cases, but did not predispose patients to worse overall outcomes. Adjunctive arterial branch interventions should be included in the treatment paradigm for TBAD with end organ malperfusion that does not improve with primary entry tear coverage alone.