Optimal Timing of Thoracic Endovascular Aortic Repair for Late Remodeling in Acute Type B Dissection

Abstract

BackgroundTo determine the optimal timing of thoracic endovascular aortic repair (TEVAR) for acute type B aortic dissection (TBAD), we investigated the relationship between the timing of TEVAR after onset and late aortic remodeling. MethodsBetween March 2015 and August 2020, 48 patients with TBAD (39 men [81.2%]; aged 61.0 ± 10.6 years) underwent TEVAR in the acute phase (within 14 days; n = 23), subacute phase (15-90 days; n = 13), or chronic phase (>90 days; n = 12). These 3 groups were compared in terms of the true lumen (TL) area ratios, calculated by dividing the TL area by the aortic lumen area on the computed tomography image at 1 week, 1 year, 2 years, and 3 years after TEVAR. ResultsAt the distal-end level of the TEVAR stent, there were significant negative correlations between TEVAR timing and TL area ratio, and the cutoff value for the most effective TEVAR timing for late aortic remodeling was 14 and 8 days on the receiver operating characteristic curves with a TL area ratio of ≥80% at 1 year and 3 years after TEVAR, respectively. ConclusionsIn patients with acute TBAD, acute phase TEVAR (within 14 days after onset) may be an optimal strategy to obtain sufficient aortic remodeling for a long-term postoperative period.