Early Thoracic Endovascular Aortic Repair for Type B Aortic Dissection Increases the Success of Aortic Remodeling

Type B aortic dissection (TBAD) is treated with thoracic endovascular aortic repair (TEVAR). However, the optimal timing of the surgical intervention remains unclear. We aimed to investigate whether the timing of TEVAR impacts aortic remodeling.

Forty-three patients with TBAD (31 men and 12 women) who had undergone surgical intervention with TEVAR between January 2014 and June 2021 were retrospectively evaluated. The relationship between the timing of TEVAR and success of aortic remodeling was assessed using linear regression analysis. Successful aortic remodeling was defined by a reduction of diametric ratio (false lumen/aorta) at 3 points (thoracic region, thoracoabdominal region, and abdominal region) and measured using computed tomography both pre- and post-operatively. The level of statistical significance was set at P < 0.05.

The timing of TEVAR after symptom onset was defined as early (≤14 days, n = 27, group E) or late (≥15 days, n = 16, group L). The median duration from symptom onset to TEVAR in groups E and L were 3 days (interquartile range [IQR], 1.5-6 days) and 196 days (IQR, 89.8-252.3 days), respectively (P < 0.001). Patent type, rupture, malperfusion, and continuous pain were present preoperatively in 82%, 3.7%, 14.8%, and 33.3% of patients in group E, respectively, and in 37.5%, 0%, 6.3%, and 0% of patients in group L, respectively. In group E, thoracic aortic diameter and false luminal thickness were decreased significantly from pre- to post-operation (36.9 ± 12.4 vs. 35 ± 12.7 mm, P = 0.03; 13.6 ± 6.2 vs. 3.4 ± 4.5 mm, P < 0.001, respectively). Whereas, thoracic aortic diameter significantly increased, and false luminal thickness did not significantly change pre- and post-operation in group L (32.7 ± 9.5 vs. 37 ± 12.8 mm, P = 0.041; 9.1 ± 4.5 vs. 7.5 ± 9.5 mm, P = 0.4, respectively).

Our results suggest that early intervention for TBAD with TEVAR increases the success of aortic remodeling.