Mid-and Long-Term Outcomes of Thoracic Endovascular with Branch Artery Revascularization in the Aortic Repair for...

This study aimed to evaluate mid-and long-term outcomes of thoracic endovascular aortic repair (TEVAR) with individualized supra-aortic branch management strategies for acute/subacute non-A non-B aortic dissection. A retrospective cohort of 113 acute/subacute non-A non-B aortic dissection patients (January 2012-April 2024) was categorized into three groups based on endovascular techniques: non-revascularization (n=63), in-situ fenestration (n=22), and Ex-situ fenestration (n=28). The primary endpoint was all-cause mortality. Secondary endpoints included a range of follow-up aortic adverse events (AEs) and re-intervention during follow-up.Survival and risk factors were analyzed using Kaplan-Meier curves and Cox regression. The early outcomes demonstrated a high technical success rate of 96.5% with low 30-day mortality (0.9%). Endoleak patterns differed significantly between approaches, with type Ia endoleaks predominating in non-revascularization cases (36.5%) while ex-situ fenestration showed higher rates of type III endoleaks (50.0%). At a median follow-up of 45 months, all-cause mortality reached 15.7%, with the highest mortality observed in the in-situ fenestration group (22.7% vs. 3.7% for ex-situ fenestration and 18.4% for non-revascularization). The re-intervention rate was 15.6%, primarily addressing stent-induced new entry (SINE) or persistent endoleaks. Notably, ex-situ fenestration exhibited more favorable survival trends（3053 d(2833, 3276)，p=0.13） and superior type III endoleak resolution (53.3%). Multivariate analysis identified age (HR=1.13, p=0.019) and thoracic aortic diameter (HR=1.126, p=0.002) as independent predictors of mortality. Thoracic endovascular aortic repair represents a safe and effective alternative to open repair for selected non-A non-B aortic dissection cases. While in-situ fenestration is associated with inferior long-term outcomes, particularly in anatomically challenging arches, ex-situ fenestration demonstrates favorable results despite higher initial type III endoleak rates, with most complications being self-limiting. The study underscores the importance of individualized technique selection and tailored antithrombotic therapy to mitigate cerebral hemorrhage risk.