Early outcomes of thoracic endovascular aortic repair in treating type B aortic dissection

Abstract

We evaluated the treatment results and aortic remodeling of Stanford type B aortic dissection （ TBAD ） following thoracic endovascular aortic repair （ TEVAR ） to determine the optimal timing to operate. Based on the duration from the onset of TBAD to surgery, 17 patients who underwent TEVAR for TBAD were divided into early （ n ＝ 10, TEVAR ＜ 3 months from onset ） and late （ n ＝ 7, TEVAR≥3 months from onset ） groups. True- and false-lumen areas were measured at four levels （ A - D ） using contrast-enhanced computed tomography before and after TEVAR : A, immediately after the left subclavian artery branching ; B, descending aorta at the tracheal bifurcation ; C, aortic annulus ; and D, diaphragm. The durations from the onset of TBAD to TEVAR were 46 ± 25 days and 7.0 ± 5.3 years in the early and late groups, respectively. No major intraoperative complications were observed in either group. However, the early group had one case of retrograde type A aortic dissection 54 days after TEVAR. In the early group, true-lumen area increased at all levels, except at level A, whereas false-lumen areas decreased at all levels （ p ＜ 0.05 ） . The late group showed no tendencies, except for an increased true-lumen area at level B. A difference in early aortic remodeling was observed ― true-lumen area enlargement and false-lumen area decrease were more marked in the early group than the late group. TEVAR is useful when performed early after TBAD onset （ within 3 months ） and results in good aortic remodeling. In the late phase, the effect might be relatively smaller.