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. 2022 May 17:9:847368.
doi: 10.3389/fcvm.2022.847368. eCollection 2022.

Five-Year Results of Aortic Remodeling for Acute, Subacute, and Chronic Type B Aortic Dissection Following Endovascular Repair

Guangmin Yang  1   2 , Hongwei Ge  3 , Guangyan Wu  1 , Yepeng Zhang  1 , Leiyang Zhang  2 , Ming Zhang  1 , Xiaoqiang Li  1 , Min Zhou  1
Affiliations

Five-Year Results of Aortic Remodeling for Acute, Subacute, and Chronic Type B Aortic Dissection Following Endovascular Repair

Guangmin Yang et al. Front Cardiovasc Med. .

Abstract

Background: This study was performed to compare aortic remodeling and clinical outcomes in patients with acute, subacute, and chronic type B aortic dissection (TBAD) after thoracic endovascular aortic repair (TEVAR).

Methods: We retrospectively examined 323 consecutive patients with acute (n = 129), subacute (n = 161), and chronic (n = 33) TBAD who underwent TEVAR from June 2013 to December 2016 in in multicenter institution. Patient demographics, clinical data, and imaging characteristics were recorded and compared among the three groups.

Results: The three groups had comparable baseline characteristics. Perioperative mortality rates were similar among the acute (2.3%), subacute (0.0%), and chronic (0.0%) groups (P = 0.34). Perioperative morbidity rates, including the rates of visceral and lower limb malperfusion and cerebral infraction, were also similar. The rate of perioperative endoleak was significantly higher in the chronic group (18.1%) than in the acute (3.9%) and subacute (3.7%) groups (P = 0.02). The mean follow-up duration was 78 ± 22 months (range, 36-101 months). The mortality rates were comparable among the three groups. The rates of reintervention and lower limb malperfusion were higher in the chronic group than in the acute and subacute groups. FL diameter reduction were more robust in the acute and subacute groups than in the chronic group.

Conclusion: Patients with acute, subacute, and chronic TBAD had different outcomes in this study. Patients with acute and subacute TBAD had fewer complications than those with chronic TBAD. Aortic remodeling after TEVAR was more favorable in patients with acute and subacute TBAD than in patients with chronic TBAD. TEVAR promotes more positive remodeling at the stent graft level than at the distal level of the aorta.

Keywords: aortic remodeling; endoleak; multicenter-center retrospective cohort study type B aortic dissection; thoracic endovascular aortic repair; type B aortic dissection.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
The central luminal line is installed which allows a “stretch view” to be produced (D). This allows accurate determination of anatomic landmarks and precise location of measurements. Diameters (A) and areas (B,C) are measured using multiplanar reconstructions of the computed tomographic images in the plane perpendicular to the central luminal line using the appropriate measurement tools (D).
FIGURE 2
FIGURE 2
Proportion of patients with aortic remodeling (positive remodeling, no remodeling, and progression) during the CTA follow-up after thoracic endovascular aortic repair.
FIGURE 3
FIGURE 3
A three-dimensional computed tomography angiography (CTA) is shown in a patient with type B aortic dissection (TBAD; A). An intraoperative angiogram demonstrates TBAD (B). A Post-operative angiogram after thoracic endovascular aortic repair (TEVAR; B’). Preoperative view with a patent false lumen (C). False lumen obliteration after TEVAR (C’). Completion angiogram after successful repair of TBAD shows the coverage of primary entry and no evidence of endoleak (D).
See this image and copyright information in PMC

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