Morphometric Aortic Remodeling and Mid-Term Outcomes After TEVAR for Acute Stanford Type B Aortic Dissection: A...

Objectives: This study aimed to evaluate the impact of thoracic endovascular aortic repair (TEVAR) on aortic remodeling using CT angiography-based morphometric measurements and to examine associated mid-term clinical outcomes in patients with acute Stanford type B aortic dissection. Methods: This retrospective, single-center observational cohort study included 33 consecutive patients who underwent TEVAR for acute Stanford type B aortic dissection between January 2020 and January 2025. Preoperative and postoperative true lumen (TL), false lumen (FL), and descending aorta (DA) diameters were compared using paired t-tests after Shapiro-Wilk normality testing. Endoleak, reintervention, FL thrombosis, and mortality were analyzed. Univariable analyses identified factors associated with endoleak and reintervention. Spearman's correlation assessed factors associated with morphometric remodeling response. Results: All 33 patients had acute Stanford type B dissection (mean time to intervention: 2.73 ± 3.86 days). Among 33 patients (81.8% male; mean age 53.6 ± 12.1 years), mean follow-up was 4.08 ± 1.66 years. TEVAR induced a significant aortic remodeling response: TL diameter increased from 9.55 ± 5.91 mm to 28.30 ± 5.49 mm (+18.76 ± 8.83 mm; p < 0.001) and FL diameter decreased from 33.39 ± 6.76 mm to 11.48 ± 8.97 mm (-21.91 ± 9.53 mm; p < 0.001), while DA diameter remained stable (42.94 ± 6.90 vs. 42.03 ± 9.46 mm; p = 0.323). Complete FL thrombosis was achieved in 19 patients (57.6%). Endoleak occurred in nine patients (27.3%); Zone 2 landing was significantly associated with endoleak (54.5% vs. 13.6%, p = 0.033). Secondary intervention was required in 13 patients (39.4%). Overall mortality was 12.1%. Narrower preoperative TL was strongly associated with greater TL expansion (Spearman r = -0.724, p < 0.001); longer stent-graft coverage was associated with greater TL gain (r = +0.522, p = 0.002). Conclusions: TEVAR induced clinically meaningful aortic remodeling in acute Stanford type B dissection without progressive aortic enlargement. A narrower baseline TL and longer stent-graft coverage were associated with greater remodeling benefit. Zone 2 deployment was significantly associated with higher endoleak rates, underscoring the value of careful preprocedural planning and systematic long-term imaging surveillance.