Mid-Term Outcomes Following TEVAR for Chronic Type B Aortic Dissection.

Area of Science:

• Vascular Surgery
• Cardiovascular Research
• Medical Imaging

Background:

• Chronic type B aortic dissection (TBD) presents complex challenges in thoracic false lumen remodeling.
• Thoracic endovascular aortic repair (TEVAR) is a treatment option, but mid-term outcomes require further investigation.
• Understanding factors influencing late thoracic false lumen remodeling is crucial for optimizing TEVAR in chronic TBD.

Purpose of the Study:

• To evaluate mid-term outcomes of TEVAR for chronic TBD.
• To identify the specific re-entry closure technique that influences thoracic false lumen remodeling in late chronic TBD.
• To correlate re-entry closure locations with thoracic false lumen changes post-TEVAR.

Main Methods:

• Retrospective analysis of 25 patients with chronic TBD undergoing TEVAR from April 2017 to April 2022.
• Categorization into early and late chronic TBD groups based on intervention timing.
• Assessment of thoracic false lumen remodeling, including complete shrinkage and diameter reduction, in relation to re-entry closure sites (renal artery, infrarenal aorta, iliac arteries).

Main Results:

• Complete thoracic false lumen shrinkage was observed in 67% of early chronic cases versus 13% of late chronic cases.
• Significant thoracic false lumen shrinkage (>5 mm diameter) was achieved in 78% of early and 69% of late chronic cases.
• Logistic regression analysis identified common or external iliac artery re-entry closure as a significant factor affecting thoracic false lumen remodeling in late chronic TBD.

Conclusions:

• Re-entry closure in the common or external iliac artery significantly influences thoracic false lumen remodeling following TEVAR in late chronic TBD.
• Targeting iliac artery re-entry may be a critical strategy for improving long-term outcomes in this patient population.
• Further research is warranted to elucidate the precise mechanisms and clinical implications of iliac artery re-entry closure in chronic TBD management.