Type B Aortic Dissection Research Articles (Page 1)

To evaluate and compare outcomes of single- and double-fenestrated physician-modified endovascular grafts (PMEGs) for aortic arch pathologies treated in an emergent setting. All patients consecutively treated for an emergent aortic arch pathology were included in this retrospective single-center cohort study between July 2014 and March 2023. In each case, the distal smaller fenestration for the left subclavian artery (LSA) was the only 1 stented. For a double-fenestrated endograft, a proximal larger fenestration that incorporated both the brachiocephalic trunk and the left common carotid artery was added. A total of 86 patients with complicated aortic arch lesions were treated, with 74% being men and a mean age of 68 years. Of these, 63% underwent single LSA fenestration, while 37% had double-fenestrated thoracic endovascular aortic repair. The main indications for repair included acute complicated type B aortic dissection (TBAD) (54%), traumatic transection of the aorta (TTA) (19%), and other conditions such as penetrating aortic ulcer (PAU), degenerative aneurysm (DA), pseudoaneurysm (PSA), and aortic thrombus. The technical success rate was 91%, with modification times of 10 minutes for single fenestration and 23 minutes for double fenestration. Thirty-day mortality was 19%, with no significant difference between the 2 fenestration types. Neurologic events occurred in 3 patients (3%), and 3 (3%) patients had perioperative retrograde dissection. Endoleaks occurred in 5% (type 1) and 2% (type 3), with no type 2 endoleaks. Eight patients (9%) required reintervention, and all supra-aortic trunks remained patent. During a follow-up of 27.6 months, no patients experienced aortic rupture (AR), neurological events, or required conversion to open surgery. Single and double PMEGs are suitable and reproducible treatment for emergent serious aortic arch lesions, with comparable outcomes whatever the aortic landing zone and number of fenestrations.Clinical ImpactFenestrated physician-modified endovascular grafts for emergent aortic arch repair appear to be a promising treatment, offering reproducibility, rapid deployment, and limited manipulation of supra-aortic trunks. The standardized technique eliminates the need for complex sizing and benefits from consistent aortic arch anatomy in most patients. It provides clinicians with a practical and efficient option in emergency settings, achieving high technical success with acceptable complication rates.

Introduction: Type B Aortic Dissection (TBAD) is a lethal disease. The dissection flap demonstrates morphologic and biomechanical changes as the dissection transitions from the acute to chronic phase. This study sought to delineate the changes in flap thickness in TBAD and to elucidate the relationship between flap thickness and patient-specific wall shear stress (WSS). Hypothesis: We hypothesized that the TBAD dissection flap thickens during the transition from acute to chronic phase, and the growth rate of the flap thickness is mediated by the WSS. Methods: A total of 18 computed tomography (CT) images were retrospectively analyzed from nine TBAD patients treated with optimal medical therapy, with each patient having two scans (Scan 1: acute phase; Scan 2: chronic phase). The flap thickness was measured from the CT cross-section (Fig. 1a and 1b) at three locations, approximately evenly distributed in the longitudinal direction of the flap, for Scan 1 and Scan 2 of each patient. Patient-specific computational fluid dynamics (CFD) was performed based on the CT-derived three-dimensional geometry of the TBAD (Scan 1), and the WSS at the same location as the measured flap thickness was obtained from the CFD flow profile. Results: The flap thickness at a total of 54 locations was obtained in the acute (n=27) and chronic (n=27) phase of the nine TBAD patients. Statistical analyses (Fig. 1c) showed that the flap thickness increased significantly as the acute TBAD transitions to the chronic phase (1.275±0.035 mm vs. 1.535±0.041 mm, p<0.001). The WSS has a strong positive correlation with the flap thickness growth rate (Fig. 1d, R=0.8261, p<0.001). Conclusions: The dissection flap thickens as the aorta transitions from the acute to chronic phase in TBAD, and regions exposed to higher WSS exhibit faster growth. These findings implicate hemodynamic loading as a key mediator of flap remodeling and highlight WSS as a potentially actionable target for risk stratification and therapeutic planning in chronic TBAD.

Background: The optimal timing of preemptive thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD) remains controversial. In the chronic phase, favorable aortic remodeling is considered less likely. Previous studies suggest that the degree of intimal flap mobility may correlate with remodeling, possibly reflecting the extent of fibrosis within the intimal flap. We investigated whether higher intimal flap mobility, as assessed by intravascular ultrasound (IVUS), predicts aortic remodeling following TEVAR in TBAD. Methods: In this multicenter retrospective study, 79 patients who underwent TEVAR for TBAD using IVUS between April 2019 and December 2024 were evaluated. Aortic remodeling was defined as complete resolution of the false lumen (FL) in the descending thoracic aorta. The non-remodeling group included cases in which the FL persisted. IVUS was used to measure the maximum and minimum true lumen (TL) areas at the site of maximal flap mobility (Fig 1). Intimal flap mobility was quantified as the TL area increase rate (ΔTL%) = (max TL area – min TL area) / min TL area × 100. A Volcano Visions® PV.035 IVUS catheter was used for all measurements. Results: Of all patients, 61% achieved complete remodeling. Baseline characteristics, including age (55.2±11.4 vs. 58.8±12.5 years, p=0.336) were similar between groups. However, chronic kidney disease (CKD) was more prevalent in the non-remodeling group (13% vs. 55%, p=0.003), and the interval from TBAD onset to TEVAR was significantly shorter in the remodeling group (95±214 vs. 1244±1653 days, p=0.001). The ΔTL% was significantly higher in the remodeling group (87±68% vs. 34±45%, p=0.007). Multivariate analysis identified a ΔTL% >43% as an independent predictor of remodeling (OR 5.6, 95% CI 1.4–22.4, p=0.015), even after adjusting for CKD and timing of intervention. Receiver operating characteristic (ROC) curve analysis yielded an AUC of 0.79, with a 43% cut-off predicting remodeling with 75% sensitivity and 77% specificity. Conclusions: Intimal flap mobility, as assessed by TL area dynamics on IVUS, is an independent predictor of favorable aortic remodeling after TEVAR in TBAD. Preoperative evaluation of flap mobility may play a critical role in tailoring therapeutic strategies and timing, particularly during the chronic phase.

Background: Type B aortic dissection (TBAD) occurs when a tear develops in the intimal layer of the descending aorta. Aortic expansion remains a major factor limiting acuate uncomplicated TBAD patients’ survival outcomes. Accurately predicting aortic diameter growth may guide the selection of optimal treatment strategies on a patient-specific basis, improving patient survival. We developed a voxel-based statistical shape modeling (SSM) approach for complex, multi-label TBAD anatomies and hypothesized that the extracted shape features could predict aortic growth. Methods: 55 clinical CT scans from 22 patients at diagnosis and follow-up were obtained. The true and false lumens, dissection flap, fenestrations, and thrombus were segmented from the CT images. Each patient’s geometry included three anatomical components: (1) true and false lumens represented by voxel segmentations, (2) thrombus modeled with a voxel grid within the false lumen, and (3) fenestrations mapped onto a surface pixel grid of the dissection flap. This representation enabled construction of three independent statistical shape models (SSMs) for the individual components. Principal component analysis was applied to each component after converting the voxel- and pixel-based representations into continuous forms. The resulting SSM-derived shape features were used to predict aortic diameter growth rates via linear regression with leave-one-out (LOO) cross-validation. Results: The first eight SSM shape modes from each of the true and false lumen, thrombus, and fenestration models explained 88%, 92%, and 66% of shape variation, respectively. Figure (A) shows the mean TBAD shape and the first mode of variation from each SSM. These anatomical shape features derived from the SSMs were used to predict aortic growth rates using linear regression. Fig. (B) shows the actual versus predicted growth rates from leave-one-out cross-validation. The results demonstrated a root mean square error (RMSE) of 1.29 mm, with 87.5% of the predicted growth rates falling within one standard deviation of the actual growth rates. Conclusion: The novel voxel-based shape representation enabled the construction of independent SSMs for distinct anatomical components of TBAD, allowing for detailed modeling of complex shape features. The combination of SSM-derived shape features from voxel-based representations with linear regression presents a promising strategy for predicting aortic growth rates.

Background: An aortic pseudoaneurysm (APA) is a contained rupture of the aortic wall that is often asymptomatic and detected as an incidental imaging finding. APAs can result from blunt thoracic trauma or can be iatrogenic. APAs secondary to aortic dissections are rare, and can lead to severe complications including rupture, hemorrhage, and death. Due to its high-risk nature, once discovered, prompt surgical or endovascular repair is important to prevent further complications. Case/Methods: A 42-year-old male with history of a Type A aortic dissection with surgical repair 3 years earlier, resistant hypertension, hyperlipidemia, and prior tobacco use, presented for chest pain radiating to his back. Physical exam was notable for a 2/6 systolic murmur, most prominent at the aortic position. Initial vitals were significant for hypertension, with a blood pressure of 164/105 mmHg. Laboratory testing showed troponin elevated to 30 ng/L (reference < 15 ng/L), with a stable 3-hour trend. EKG showed normal sinus rhythm with left axis deviation and left ventricular hypertrophy. A CT angiography (CTA) dissection protocol showed a dissection flap distal to the left subclavian artery, extending into the abdominal aorta, consistent with a Stanford Type B aortic dissection (TBAD). The patient was managed with beta blockers and vasodilators to maintain systolic blood pressure under 120 mmHg and heart rate under 60 beats per minute. Following symptom resolution, a repeat thoracic CTA revealed a 2.5 cm sac near the origin of the right main coronary artery, representing a pseudoaneurysm not seen prior. Subsequent cardiac CTA confirmed this pseudoaneurysm outpouching secondary to degeneration of the TBAD. The patient underwent successful pseudoaneurysm repair with anastomosis construction and Dacron patch placement. Discussion: While the patient’s initial presentation and imaging studies, consistent with a TBAD, suggested conservative management, repeat imaging was imperative and changed the therapeutic plan despite the resolution of his symptoms. Current ACC/AHA guidelines recommend medical management for uncomplicated Type B dissections with close monitoring; however, aneurysmal progression mandates timely surgical intervention to mitigate rupture risk. This case highlights the importance of serial imaging in patients with TBADs to detect evolving complications such as APA formation, which may initially be occult but carry high mortality risk if left untreated.

Introduction: Type B aortic dissection (TBAD) is a serious condition that may benefit from early endovascular repair. In the acute phase (aTBAD; <14 days onset), the high compliance of the dissection flap improves success of endovascular repair. In the chronic phase (cTBAD; >90 days onset), the flap stiffens and makes endovascular repair less effective. This study aimed to better characterize dissection flap behavior and understand the cause of stiffening. Hypothesis: We hypothesize that remodeling of the dissection flap in TBAD leads to decreased dynamic displacement over time, driven by structural thickening and stiffening. Methods: We combined in vivo imaging and ex vivo tissue analyses. A total of 15 2D phase-contrast magnetic resonance imaging (PC-MRI) datasets were analyzed (4 cTBAD; 11 aTBAD). For dissection flap thickness, a separate cohort of 41 tissue samples were used (20 cTBAD; 10 aTBAD, 11 control). We used an in-house MATLAB code to analyze flap motion in the 2D PC-MRI data. We extracted maximum displacement by calculating the Euclidean distance between corresponding points on the flap at systole and diastole. After surgical excision, dissection flap samples were placed into cryopreservation medium (10% DMSO + 90% RPMI) and stored in a -80 °C freezer. Prior to measurement, tissue was thawed at around 37 °C, and tissue thickness was measured by a micrometer. Control dissection flaps were created by peeling healthy descending aortic tissue at the level of the media and combined intimal and partial medial layers were measured together as control flap thickness. Group differences were assessed using the Mann-Whitney U test. Results: 2D PC-MRI revealed large differences in dissection flap displacement between cTBAD and aTBAD (Fig. 1A,B). Mean maximum displacements in the acute group (5.4±1.9 mm) were significantly higher than chronic (1.5±1.1 mm; p < 0.01). Thickness measurements of the dissection flaps varied greatly: cTBAD = 1.8±0.4, aTBAD = 1.3±0.4, control = 0.8±0.1 mm. All group comparisons revealed significant differences (Fig. 1C). Since bending stiffness is proportional to the cube of thickness, we can also expect a significant increase in chronic dissection flap stiffness. Conclusions: Dissection flaps in chronic TBAD exhibit reduced motion and increased stiffness compared to the acute phase. These properties are related to structural thickening which highlights the importance of early intervention before adverse remodeling occurs.

Aortic morphology plays a critical role in determining treatment pathways and predicting outcomes in patients presenting with acute type B aortic dissection (TBAD). However, there is no consensus on the optimal methodology for the morphological assessment of TBAD. This study aims to demonstrate the reproducibility of a comprehensive imaging protocol for the analysis of aortic morphology of TBAD for clinical and research purposes. Protocol for comprehensive assessment of TBAD morphology was designed based on systematic review and expert opinion. A total of 56 morphological parameters were assessed across 6 morphological domains: aortic arch, aortic measurement, dissection morphology, false lumen morphology, endovascular intervention, and aortic remodeling. To validate the protocol, 4 observers measured these variables on 20 computed tomographic angiograms (CTAs) on a total of 10 patients using 3-dimensional imaging reconstruction software. One observer performed repeated measurements. The intraobserver and interobserver variabilities were calculated for all continuous variables. Cohen's kappa was used to assess agreement between observers for categorical variables. Measurement time for all 56 features was recorded. Aortic arch, false lumen morphology, endovascular intervention, and aortic remodeling showed strong levels of agreement. Aortic measurements, including aortic diameter and false lumen diameter, showed satisfactory intraobserver and interobserver variabilities with maximum repeatability coefficient (RC) for interobserver variability of 5.02 mm and intraobserver variability of 2.42 mm across all measurements. False lumen thrombosis assessment revealed moderate to almost perfect agreement (κ range=.58-1) and almost perfect intraobserver agreement (κ range=1-1). Entry tear morphology, including primary entry tear (PET) size and distance from left subclavian artery (LSCA), showed small mean differences but was associated with high RCs. Location of PET lesser curve location was found to have moderate to almost perfect interobserver agreement (κ range=.58-1) and strong intraobserver agreement (κ=.73). The measurement protocol was completed in a median time of 28 (24, 35) minutes. Accurate 3-dimensional analysis of TBAD morphology can be reliably performed within a reasonable timeframe. Measurements based on consistent anatomical landmarks demonstrated the highest reproducibility. It is suggested that this protocol is adopted for clinical studies and trials on acute TBAD.Clinical ImpactThe morphological characteristics of the aorta play a pivotal role in guiding treatment strategies and prognosticating outcomes in patients with acute type B aortic dissection (TBAD). Despite its critical importance, there remains a lack of consensus regarding the optimal approach to the morphological assessment of TBAD. This study presents a standardized and internally validated protocol for the evaluation of aortic morphology. The proposed methodology is intended to facilitate both clinical decision-making and research endeavors in the context of acute TBAD.

Objective: To evaluate the value of a radiomics-based machine learning model in detecting Type-B aortic dissection (TBAD) on computed tomography (CT) images. Methodology: This retrospective analysis included one hundred records of patients with clinically diagnosed TBAD and one hundred records of non-TBAD patients treated at the First Hospital of Jiaxing from January 2010 to January 2024. Radiomics features were extracted from CT non-contrast images, and the least absolute shrinkage and selection operator (LASSO) was used to construct dimensionality reduction and prediction models. The diagnostic performance of the model was evaluated through receiver operating characteristic (ROC) curves. Results: Fifteen radiomics features were extracted from the training cohort. All eight machine learning-established radiomics models in the training cohort demonstrated good prediction accuracy, with area under the ROC curve (AUC) values exceeding 0.9 in the validation set. Among the three models compared, the AUC values of the nomogram were the highest in both the training and validation cohorts (0.991 [95% confidence interval (CI): 0.982-1.000] and 0.998 [95% CI: 0.993-1.000], respectively). The calibration curves of the nomogram in both cohorts were more closely aligned with the dashed line. The nomogram showed the highest clinical benefits in both training and validation cohorts. Conclusions: The predictive model established based on radiomics analysis of CT images demonstrates good predictive ability in recognizing TBAD.KEYWORDS: Type-B aortic dissection; Computed tomography; Radiomics; Machine learning model.

Intravascular Ultrasound Impact on Endovascular Treatment of Type B Aortic Dissection: A Single-Center Retrospective Study.

Centerline-based quantification of true Lumen helical Morphology in Type B aortic dissection: Unlocking the potential of helicity as a geometric biomarker.

Aortic dissection (AD), particularly type B aortic dissection (TBAD), is a severe vascular condition with complex biomechanical implications that pose challenges for effective treatment. Thoracic endovascular aortic repair (TEVAR) has emerged as the standard approach for acute complicated TBAD; however, its efficacy in chronic cases remains uncertain due to factors such as fibrotic dissection flap and altered aortic wall properties. Current numerical simulations of TEVAR provide valuable insights into stent-graft behavior but lack comprehensive analyses of the effect of variable thickness distributions in patient-specific aortic anatomies and sensitivity of results to procedural factors such as the guiding catheter position. This study presents a finite element-based simulation pipeline to investigate the impact of (i) thickness variations in the aortic wall and dissection flap and (ii) guiding catheter path on the predictive accuracy of TEVAR outcomes in chronic TBAD. Using a virtual catheter technique implemented in Abaqus/Explicit, stent-graft deployment was simulated in a patient-specific model. The model incorporates hexahedral meshing for wall thickness distribution to improve computational efficiency. Quantitative assessment of the model's predictions reveals strong agreement with post-TEVAR CT data when a uniform aortic wall thickness is assumed and the guiding catheter path is reconstructed based on follow-up CT scan. Specifically, the predictions show radial, longitudinal, transverse, and angular deviations of 4.14% 3.25%, 4.75 1.70 mm, 4.29 1.36 mm, and 6.08° 4.22°, respectively. Thickness variations in the dissection flap and aortic wall minimally affect stent-graft positional predictions but significantly influence radius expansion and spatial configuration.

To evaluate the safety and feasibility of thoracic endovascular repair (TEVAR) of type B aortic dissection (TBAD) with Cratos branched stent-graft. A prospective, multicenter study consisting of consecutive TBAD patients across 12 centers in China who were treated with the Cratos branched stent-graft was conducted. Outcomes were reported using descriptive statistics. Overall survival, freedom from reintervention, and branch artery patency were estimated using Kaplan-Meier estimates. The first enrollment started from January 2022 and ended in July 2023, with a total of 89 patients finally enrolled. All patients were diagnosed with TBAD and underwent TEVAR using the Cratos branched stent-graft. Technical success was achieved in all patients. One patient (1.1%) died of respiratory failure within the first 30 days after the operation. The rate was 1.1% for both stroke and spinal cord ischemia. The median follow-up was 369 days. Two patients (2.2%) died during follow-up, and neither death was related to the aorta. One patient had reintervention because of retrograde type A aortic dissection (RTAD). Two cases of endoleak resolved spontaneously but the one with RTAD and type Ia endoleak. Eighty-one patients completed a 12-month computed tomography angiography. The patency rate for the branch section was 95.06%. At the segment covered by the stent-graft, the complete thrombosis rate was 92.59% (75/81) at 12 months. Cratos branched stent-graft was a safe and feasible device for TEVAR of TBAD. The updated device exhibited easy, safe, and accurate deployment. (Chinese Clinical Trial Register identifier: ChiCTR2200064412: ChiCTR2200064412). Question How can thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD) safely provide sufficient proximal landing while maintaining left subclavian artery perfusion? Findings The Cratos unibody single-branched stent-graft achieved high technical success, low complication rates, and excellent branch patency in treating TBAD while revascularizing the left subclavian artery. Clinical relevance The Cratos stent-graft enables one-stage, minimally invasive TEVAR for TBAD, addressing the need for safe left subclavian artery coverage and revascularization, thereby improving sealing, reducing complications, and enhancing clinical outcomes.

Thoracic endovascular aortic repair (TEVAR) has become the cornerstone surgical operation of choice for treatment of type B aortic dissection (TBAD), especially in acute and subacute phases. The primary goal of TEVAR in these situations to seal proximal entry tear in the aortic dissection to promote false lumen thrombosis, prevent aneurysmal degeneration and rupture. In patients with large fenestrations between the true and false lumen in the perivisceral aorta, false lumen may still be perfused via retrograde flow from the fenestrations. As a result, complete FL thrombosis is achieved in only 40% of patients who undergo TEVAR for TBAD. Management of large fenestrations in chronic TBAD is not standardized and there is no single technique which can be used in all cases. This review summarizes different techniques that can be used to obliterate large fenestrations between true and false aortic lumens. For thoracic FL involvement without abdominal aortic segment, Knickerbocker, Candy-Plug and Cork-in-the-Bottle techniques have demonstrated good outcomes. In cases where the dissection flap extends into the perivisceral segment, PETTICOAT and STABILISE techniques can be useful. More complex dissections involving visceral branches coming off the false lumen may require F/BEVAR. Additional techniques include septotomy, transcatheter fenestration, re-entry specific therapy using plug embolization and the streamliner multilayer flow modulator. While current data support these strategies, further prospective studies are needed to establish clear guidelines for optimizing long-term management of TBAD.

Purpose To evaluate the prognostic value of the periaortic fat attenuation index (FAI), which noninvasively captures vascular inflammation on noncontrast CT images, in managing uncomplicated type B aortic dissection (TBAD). Materials and Methods In this retrospective multicenter study (January 2011-December 2022), an automated machine learning algorithm measured periaortic FAI of the descending thoracic aorta at noncontrast CT. Patients who underwent CT for chest or back pain were included to compare FAI between those with acute aortic dissection, including both type A and B, and those without. Further, prognostic evaluation of patients with uncomplicated TBAD was conducted using multivariable Cox proportional hazards regression. Results A total of 688 patients (median age, 69 years [IQR, 56-79]; 400 male patients), including 380 with acute aortic dissection and 308 without, were analyzed for the diagnostic characteristics of FAI, and 135 patients with uncomplicated TBAD (median age, 70 years [IQR, 59-79]; 90 male patients) were followed up for prognosis. FAI values at initial presentation were higher in patients with acute aortic dissection than in those without (median, -74.5 vs -78.7 HU; P < .001). In patients with uncomplicated TBAD, FAI values peaked on the 6th day after onset. These patients were divided into two groups according to the median peak FAI value of -64 HU. During a median follow up of 529 days, those with higher peak FAI values (≥-64 HU) had higher rates of all-cause death and aortic events (log-rank P < .001). High peak FAI independently predicted these events (adjusted hazard ratio, 4.54 [95% CI: 1.69, 12.21]; P = .003). Conclusion A higher peak FAI value was an independent risk factor for adverse events in patients with uncomplicated TBAD. Keywords: Acute Aortic Dissection, Fat Attenuation Index, Noncontrast CT, Perivascular Adipose Tissue, Prognosis UMIN Clinical Trials Registry (AIDFAI study no. UMIN000053435). Supplemental material is available for this article. © The Author(s) 2025. Published by the Radiological Society of North America under a CC BY 4.0 license.

Early Thoracic Endovascular Aortic Repair for Acute Type B Dissection Is Associated with Increased Complications: Results from the Gore Global Registry for Endovascular Aortic Treatment Registry.

Thoracic Endovascular Aortic Repair with Left Subclavian Artery Revascularization for Type B Aortic Dissection: Outcomes of Fenestrated Physician-Modified Stent-Graft Versus Unibody Single-Branched Stent-Graft.

BACKGROUNDSex disparities in clinical outcomes following thoracic endovascular aortic repair (TEVAR) for acute complicated type B aortic dissection (TBAD) are not well understood.AIMTo evaluates the impact of sex on primary and secondary outcomes by comparing male and female cohorts undergoing TEVAR.METHODSA systematic search of PubMed, EMBASE, Cochrane Library, and ScienceDirect identified five studies involving 2572 patients (1153 males and 1419 females). The primary outcome was hospital mortality. Secondary outcomes included reintervention rates, acute kidney injury (AKI), ischemic stroke, limb ischemia, and spinal cord ischemia. Odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model. Heterogeneity was assessed using the I² statistic.RESULTSThe primary outcome showed no significant difference between males and females for hospital mortality (OR: 1.13, 95%CI: 0.81-1.59, P = 0.47, I2 = 0). Among secondary outcomes, males had a significantly higher risk of AKI (OR: 1.55, 95%CI: 1.21-2.00, P = 0.0006, I² = 0). No differences were observed for reintervention rates, ischemic stroke, limb ischemia, or spinal cord ischemia.CONCLUSIONMale patients undergoing TEVAR for complicated TBAD are at increased risk of AKI but show comparable outcomes to females for mortality, ischemic events, reintervention, and other complications. Future research should explore mechanisms and strategies to optimize outcomes.

Preoperative constipation in patients with Stanford type B aortic dissection (TBAD) poses significant risks by increasing abdominal pressure, potentially complicating aortic stability. Traditional constipation management may be limited by both physiological and psychological factors. This study evaluates the efficacy of auricular acupressure combined with virtual reality (VR) technology in preventing preoperative constipation in TBAD patients, exploring its impact on both constipation severity and nursing satisfaction. This retrospective study included 116 patients with TBAD who received preoperative care at our hospital from January 2022 to December 2023. Participants were divided into 2 groups: a control group (n = 60) receiving standard care and an observation group (n = 56) receiving auricular acupressure combined with VR in addition to standard care. Data on constipation severity were collected pre- and posttreatment using the Wexner Constipation Score and Bristol Stool Form Scale, while nursing satisfaction was evaluated through a custom questionnaire. Statistical analyses were performed using SPSS Version 27.0 (Chicago). Pretreatment constipation scores showed no significant differences between groups. Posttreatment, however, the observation group demonstrated significantly improved scores for both the Wexner Constipation Score (from 12.94 ± 3.28 to 4.14 ± 1.23, P < .001) and the Bristol Stool Scale (from 1.50 ± 0.46 to 4.41 ± 1.39, P < .001) compared to the control group. Nursing satisfaction rates were also higher in the observation group, with an overall satisfaction rate of 94.6%, significantly surpassing the 78.3% in the control group (P = .010). Auricular acupressure combined with VR technology effectively reduces preoperative constipation severity and enhances nursing satisfaction in TBAD patients. This integrative, non-pharmacologic approach addresses both physiological and psychological factors, suggesting a valuable addition to conventional preoperative care protocols in this high-risk population.

Aorta, particularly in its proximal segments, expands during systole to store blood, which is subsequently released into the peripheral circulation during diastole, morphologically and histologically. This function, referred to as the "Windkessel effect," ensures continuous and regular blood flow in the peripheral circulation. Thoracic Endovascular Aortic Repair (TEVAR) was introduced in the literature as a treatment for Type B aortic dissections (TBAD). In patients who undergo TEVAR, the placement of a stent graft in the proximal segments of the aorta, which are responsible for the highest capacity of blood storage and elasticity, may disrupt this function. Consequently, this alteration may lead to increased afterload and, over the long term, impair left ventricular systolic function. Previous studies have demonstrated that measurements of left ventricular global longitudinal strain (LVGLS) can detect early systolic dysfunction before any significant changes in left ventricular ejection fraction (LVEF) occur. The aim of this study is to compare preoperative and postoperative LVGLS measurements in patients who underwent TEVAR, thereby illustrating changes in LVGLS associated with the procedure. Patients who underwent TEVAR for TBAD or Thoracic Aortic Aneurysm (TAA) were included in the study. Patients with malignancy, advanced valvular pathology, end-stage chronic kidney disease, liver failure, or heart failure were excluded. Preoperative data, including comorbidities, medication use, blood parameters, electrocardiography findings, transthoracic echocardiography images, and LVGLS values, were recorded. These parameters were then compared with the values obtained at the postoperative 3-month outpatient follow-up. After TEVAR procedure, a significant decrease in LVGLS was observed (p<0.001). A strong correlation was found between the change in mean arterial pressure (MAP) and the reduction in LVGLS (ρ=0.555, p=0.017). Postoperatively, significant increases were noted in systolic blood pressure (SBP) and MAP (both p<0.001). No significant differences were observed in other parameters before and after the procedure. In our study, a significant increase in SBP and MAP, along with a notable decrease in LVGLS values, were observed following TEVAR procedure. A significant and strong correlation was identified between the increase in MAP and the decrease in LVGLS.

To further validate the pressure change within the true (TL) and false lumens (FL), we conducted intraoperative pressure measurements. This study aimed to evaluate intraoperative pressure changes within TL and FL in patients with TBAD undergoing TEVAR. This study analyzed a cohort of 23 patients with type B aortic dissection (TBAD) who underwent thoracic endovascular aortic repair (TEVAR) at a single institution between 2021 and 2024. Intraoperative pressure measurements were recorded to evaluate changes in the TL and FL at various levels. Additionally, blood pressure waveforms and digital subtraction angiography of both the TL and FL were assessed. During TEVAR in 23 patients with TBAD, intraoperative measurements showed a significant reduction in FL pulse pressure difference postoperatively (40.3 ± 20.5 to 25.3 ± 14.9, p < 0.001), with no significant change in the TL. Stratified analysis revealed a significant reduction in FL pulse pressure difference in chronic-phase patients (45.0 ± 20.9 to 28.9 ± 17.5, p = 0.002). Additionally, 73.9% of patients had higher systolic pressure in TL with an earlier systolic peak, multivariable analysis identified more visceral arteries originating from FL (OR = 0.02, 95% CI = 0.01-0.47) and FL being closer to the spine (OR = 0.05, 95% CI = 0.01-0.77) as factors associated with higher FL systolic pressure. During follow-up, one patient died, and two required reintervention for aortic enlargement. The involvement of branch arteries is highly correlated with elevated false lumen systolic pressure in patients, and TEVAR can effectively change FL pressure.