Long-term outcomes of aortic arch preemptive thoracic endovascular aortic repair for uncomplicated type B aortic...

Preemptive thoracic endovascular aortic repair (TEVAR) has been used increasingly for uncomplicated type B aortic dissection (TBAD); however, its optimal indications remain controversial, particularly when the proximal landing zone involves the aortic arch. We evaluated the long-term outcomes of aortic arch preemptive TEVAR for uncomplicated TBAD.

Between July 2004 and January 2026, 473 patients with acute TBAD were treated at our institution and affiliated hospitals, 351 of whom completed initial medical therapy (follow-up, 1-241 months). Preemptive TEVAR was performed in 52 patients and 299 were managed medically. The subjects of this study were 41 patients who underwent preemptive TEVAR with a proximal landing zone in Zone 2 or 3. We compared the outcomes and aortic morphology on serial computed tomography (CT) of these 41 patients with those of 41 propensity-matched patients who did not undergo TEVAR.

Before matching, the TEVAR group had a higher prevalence of patent false lumen and a larger false lumen diameter. Freedom from aortic adverse events was higher in the TEVAR group during long-term follow-up, although the difference was not significant (P = 0.065). There were no aortic-related deaths after TEVAR, and CT demonstrated favorable aortic remodeling.

Aortic arch preemptive TEVAR was associated with favorable aortic remodeling and a trend toward improved long-term aortic outcomes.