Remodeling, Reintervention, and Survival After Endovascular Repair of Chronic Type B Dissection

Abstract

The efficacy of thoracic endovascular aortic repair (TEVAR) of chronic type B aortic dissection (cTBAD) is controversial. Only limited evidence describes temporal anatomic changes after TEVAR for cTBAD and their relationship to outcomes. We sought to investigate early aortic remodeling events after TEVAR for cTBAD with thoracic aneurysm and determine the association with reintervention and survival. Records from 95 cTBAD patients undergoing TEVAR from 2005 to 2017 were reviewed. Using 3-dimensional centerline analysis, anatomic phenotyping of the thoracoabdominal aorta was performed. Reverse aortic remodeling (RAR) was defined by a ≥5-mm reduction in maximal thoracic aortic diameter. Kaplan-Meier analysis estimated freedom from reintervention and survival. Visceral segment dissection involvement was present in 89% of patients (n= 85), and the mean preoperative thoracic diameter was 63 mm (SD, 10). Complete thoracic false lumen thrombosis occurred in 71% of patients (n= 67), whereas abdominal false lumen thrombosis was documented in 60% (n= 57) by 6 months. RAR occurred in 41%. Aortic reintervention rate was 39% (n= 37). The 1- and 3-year freedom from reintervention was significantly higher in subjects experiencing early RAR (log-rank P= .02), but reintervention did not impact overall survival (log-rank P= .9). Similarly, overall survival was similar between patients with or without RAR (log-rank P= .4). Early RAR is associated with decreased rates of reintervention; however, overall survival is not impacted by these changes. TEVAR for cTBAD results in a high rate of reintervention, which mandates vigilant surveillance protocols.