Late Aortic Expansion After Thoracic Endovascular Aortic Repair for Chronic DeBakey IIIb Dissection

Abstract

The efficacy of thoracic endovascular aortic repair (TEVAR) for chronic DeBakey IIIb aortic dissection is still under discussion. This study was performed to investigate the incidence of and risk factors for late aortic expansion after TEVAR for chronic DeBakey IIIb aortic dissection. From March 2014 to April 2019, a total of 35 patients with chronic DeBakey IIIb aortic dissection underwent TEVAR in our institution. Risk factors for aortic expansion events were examined by stepwise Cox regression analysis. Aortic expansion events were defined as reintervention for expansion or aortic expansion of greater than 5 mm. No operative death occurred, and the 2-year survival rate was 96.8%. The 1- and 2-year rates of freedom from reintervention were 87.8% and 80.2%, respectively. During follow-up, 11 patients had late aortic expansion events (4 with expansion of the thoracic aorta and 7 with expansion of the abdominal aorta). The 1- and 2-year rates of freedom from aortic expansion were 87.8% and 68.7%, respectively. Significant risk factors for expansion events were aortic dilation at the celiac level (hazard ratio [HR], 1.11; P= .015), saccular aneurysm formation of the false lumen (HR, 5.08; P= .049), and high number of residual large reentries (>5 mm) (HR, 2.78; P= .027). In patients undergoing TEVAR for chronic DeBakey IIIb aortic dissection, late aortic expansion in both the thoracic and abdominal aorta remains an important issue. Aggressive additional intervention should be considered for high-risk patients with residual large reentries and aortic dilation at the celiac level.