Outcomes of Selective Strategies for Distal Entry Tears After Thoracic Endovascular Aortic Repair in Type B Aortic...

Distal entry tears have undesirable influence in type B aortic dissection (TBAD) after thoracic endovascular aortic repair (TEVAR), including inhibition of aortic remolding and increase of late aortic events. Therefore, distal entry tears should be managed. Nowadays, main strategies for managing distal entry tears included total and selective strategies. However, which strategy is better still remains controversial. The objective of the study is to investigate the outcomes of selective strategy for distal entry tears after TEVAR in TBAD.

A total of 43 consecutive patients with TBAD with distal entry tears after TEVAR were administered with selective strategy for distal entry tears, including occlusion of the tear in the thoracic aortic segment, thrombosis of the reverse blood flow channel in the false lumen, and selective occlusion of distal entry tears. Mortality, complications, and aortic remolding in early follow-up (12 months after operation) were analyzed.

All 43 patients survived during the follow-up period. Operation was performed again for femoral artery reconstruction in 1 patient who had occlusion of the approach vessel during the follow-up period, and the remaining 42 patients had no uncomfortable symptoms and operation-related complications. The maximum diameter of the aorta was 32.03 ± 6.35 mm and 27.36 ± 4.92 mm, respectively, for before and after reintervention, and the difference was significant (t = 5.899, P < 0.001). The unthrombotic range of the false lumen after reintervention was significantly shrunken in all patients, compared with the range before reintervention.

Selective strategy was safe and effective, at least in early follow-up. Its effectiveness should be further verified by more clinical observation results and long-term follow-up results.