Thirty-Day Endovascular Repair Outcomes of Stanford Type B Aortic Dissection in Patients With Diabetes Mellitus: A Propensity-Score-Matched Study From the ACS-NSQIP Database

Abstract

Background:

The surgical intervention for Stanford type B aortic dissection (TBAD) has been revolutionized by thoracic endovascular aortic repair (TEVAR). While diabetes mellitus (DM) is associated with increased risks of short-term mortality and infectious complications after major surgeries, previous studies present conflicting findings regarding the outcomes of TEVAR in DM patients. This study aimed to assess the 30-day postoperative outcomes for DM patients who have undergone TEVAR for TBAD using a dataset from a multi-institutional national registry.

Methods:

Patients who underwent TEVAR for TBAD were selected from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2022. A 1:4 propensity-score matching was used to balance demographics and preoperative characteristics between patients with and without DM. Thirty-day postoperative outcomes were compared.

Results:

There were 160 (8.89%) DM and 1640 (91.11%) non-DM patients who underwent TEVAR for TBAD. After propensity-score matching, all DM patients were matched to 594 non-DM patients. DM patients had a higher rate of mortality that was trending toward significance (10.19% vs 5.89%, p = 0.07). All 30-day complications were comparable between DM and non-DM patients.

Conclusion:

TEVAR can generally be safe for DM patients in terms of short-term outcomes, but the potential for higher perioperative mortality rates in these patients may warrant careful consideration. Further large-scale studies may be necessary to fully understand the impact of DM on both short-term and long-term outcomes following TEVAR for TBAD.

Clinical Impact

This study assessed the 30-day postoperative outcomes for diabetes mellitus (DM) patients who have undergone thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection (TBAD) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. After propensity-score matching, DM patients had a higher rate of mortality that was trending toward significance but all 30-day complications were comparable between DM and non-DM patients. Therefore, TEVAR can generally be safe for DM patients in terms of short-term outcomes, but the potential for higher perioperative mortality rates in these patients may warrant careful consideration. Further large-scale studies may be necessary to fully understand the impact of DM on both short-term and long-term outcomes following TEVAR for TBAD.

Keywords

diabetes TEVAR type B aortic dissection endovascular descending aorta

Get full access to this article

View all access options for this article.

References

Dake

Kato

Mitchell

, et al Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med. 1999;340:1546–1552.

Fattori

Tsai

Myrmel

, et al Complicated acute type B dissection: is surgery still the best option?: a report from the International Registry of Acute Aortic Dissection. JACC Cardiovasc Interv. 2008;1:395–402.

Nienaber

Kische

Rousseau

, et al Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv. 2013;6:407–416.

Svensson

Kouchoukos

Miller

, et al Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Ann Thorac Surg. 2008;85(1 suppl):S1–S41.

Hsieh

Hsu

Lee

, et al Comparison of type B dissection by open, endovascular, and medical treatments. J Vasc Surg. 2019;70:1792–1800.e3.

Nation

Wang

GJ.

TEVAR: endovascular repair of the thoracic aorta. Semin Intervent Radiol. 2015;32:265–271.

Brunkwall

Kasprzak

Verhoeven

, et al Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial. Eur J Vasc Endovasc Surg. 2014;48:285–291.

Moulakakis

Mylonas

Dalainas

, et al Management of complicated and uncomplicated acute type B dissection. A systematic review and meta-analysis. Ann Cardiothorac Surg. 2014;3:234–246.

Nienaber

Rousseau

Eggebrecht

, et al Randomized comparison of strategies for type B aortic dissection: the INvestigation of STEnt Grafts in Aortic Dissection (INSTEAD) trial. Circulation. 2009;120:2519–2528.

10.

Sachs

Pomposelli

Hagberg

, et al Open and endovascular repair of type B aortic dissection in the Nationwide Inpatient Sample. J Vasc Surg. 2010;52:860–866; discussion 866.

11.

CDC. National diabetes statistics report. Diabetes. June 6, 2024. Accessed July 5, 2024. https://www.cdc.gov/diabetes/php/data-research/index.html

12.

Lin

Chang

Lee

, et al Adverse outcomes after major surgeries in patients with diabetes: a multicenter matched study. J Clin Med. 2019;8:100.

13.

Jiménez-Trujillo

González-Pascual

Jiménez-García

, et al Type 2 diabetes mellitus and thoracic aortic aneurysm and dissection. Medicine (Baltimore). 2016;95:e3618.

14.

Liu

Shi

Zeng

, et al Type 2 diabetes mellitus reduces clinical complications and mortality in Stanford type B aortic dissection after thoracic endovascular aortic repair: a 3-year follow-up study. Life Sci. 2019;230:104–110.

15.

Summers

Rastogi

Yadavalli

, et al The association between diabetes mellitus and its management with outcomes following endovascular repair for descending thoracic aortic aneurysm. J Vasc Surg. 2023;78:313–323.

16.

Prakash

Pedroza

Khalil

, et al Diabetes and reduced risk for thoracic aortic aneurysms and dissections: a nationwide case-control study. J Am Heart Assoc. 2012;1:jah3-e000323.

17.

Tsai

Lin

, et al Advanced complicated diabetes mellitus is associated with a reduced risk of thoracic and abdominal aortic aneurysm rupture: a population-based cohort study. Diabetes Metab Res Rev. 2015;31:190–197.