Long-term outcomes of thoracic endovascular aortic repair using a target aneurysm-based approach for extensive...

Conventional (CV) aneurysm-based success definitions are often insufficient for evaluating endovascular repair for chronic type B aortic dissection (cTBAD). This study aimed to assess the clinical validity of a target aneurysm (TA)-based treatment concept.

We retrospectively analyzed patients who underwent initial endovascular repair for extensive cTBAD between July 2007 and December 2023. The TA was defined as the aneurysmal segment requiring treatment based on size or growth criteria. Technical and clinical success were defined using both TA-based and CV frameworks. TA technical success was defined as elimination of false lumen perfusion at the TA level at procedure completion, and TA clinical success as sustained exclusion of the TA on 1-month computed tomography angiography. CV success required complete exclusion of false lumen perfusion. The primary endpoint was morphologic outcome of the TA, including changes in aneurysm size. Secondary endpoints included open conversion (OC), aorta-related death (ARD), and TA-related reinterventions.

A total of 124 patients (mean age, 62.9 ± 11.6 years; 83.9% male) were included. TA and CV technical success were achieved in 96.8% and 17.7%, respectively, whereas TA and CV clinical success at 1 month were observed in 73.9% and 14.3% of evaluable patients. During a median follow-up of 60 months (interquartile range, 29-106 months), freedom from OC, ARD, and TA-related reintervention at 5 years were 98.3%, 91.5%, and 59.7%, respectively. Morphologic outcomes at the TA level were favorable, with shrinkage or stable diameter observed in 84.0% of patients. Long-term outcomes differed significantly according to TA clinical success across all endpoints, including OC (P = .013), ARD (P = .013), and both overall and TA-related reintervention (both P < .001). TA shrinkage was more frequent in patients with TA clinical success than in those without (55.7% vs 25.8%; P = .013).

TA clinical success was strongly associated with long-term outcomes after endovascular repair for cTBAD. These findings support the validity of the TA-based treatment concept and highlight the importance of early imaging-based assessment as a clinically meaningful framework for evaluating procedural success in cTBAD. Endovascular repair of extensive cTBAD guided by the TA-based treatment concept offers favorable clinical outcomes including avoidance of thoracoabdominal repair and ARD.