Aortic Remodeling After Thoracic Endovascular Aortic Repair for Nonacute Uncomplicated Type B Aortic Dissection

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Endovascular Interventions

Background:

• Thoracic endovascular aortic repair (TEVAR) is increasingly used for Stanford type B aortic dissection (TBAD).
• Aortic remodeling is a known outcome of TEVAR in TBAD.
• Factors influencing remodeling in nonacute, uncomplicated TBAD require further investigation.

Purpose of the Study:

• To evaluate the relationship between aortic diameter and the timing of surgical intervention from onset.
• To assess their impact on aortic remodeling after TEVAR for uncomplicated nonacute TBAD.

Main Methods:

• Retrospective analysis of 40 patients with subacute/chronic uncomplicated TBAD undergoing TEVAR.
• Inclusion criteria: patent false lumen, minimum 6-month follow-up.
• Comparison of data between remodeling and nonremodeling groups.

Main Results:

• Successful TEVAR in 97.5% of cases; 55% achieved late aortic remodeling.
• Preoperative maximum aortic diameter (PMAD) >45 mm predicted nonremodeling (AUC=0.917).
• Time from onset to intervention >6.3 months predicted nonremodeling (AUC=0.743).

Conclusions:

• TEVAR for nonacute uncomplicated TBAD yields a 55% late aortic remodeling rate.
• A PMAD >45 mm or intervention >6.3 months post-onset hinders remodeling.
• These findings aid in patient selection and timing for TEVAR in TBAD.