Abstract
Objectives: Currently, thoracic Endovascular Aortic Repair (TEVAR) is increasingly used in the management of acute type B aortic dissection (TBAD). TEVAR has a role to help cover the entry tear and promote remodeling of aorta to reduce mortality. Complete false lumen thrombosis (FLT) is associated with better long-term outcome in these patients. Factors affecting aortic remodeling after TEVAR have received great attention from clinicians and are still unclear. Therefore, it is essential to evaluate aortic remodeling over time and investigate predictors of FLT. Subjects and research methods: From January 1, 2017 to August 31, 2022. Including 93 patients diagnosed with acute complicated type B aortic dissection at Viet Nam National heart Institute - Bach Mai Hospital. Patient treated by TEVAR were Prospectively reviewed for statistical analysis. Aortic remodeling was evaluated based on the preoperative and before discharge, 1 month, 6 months and 12 months postoperative followed-up aortic CTA scan results. We analyzed the diameters of the descending thoracic aorta, true and false lumen diameter and the false lumen thrombosis status. Results: A total of 93 patients with acute type B aortic dissection who underwent TEVAR during the study period were analyzed. The average age was 57,7 years (range, 31- 86 years). 84 patients (90,03%) were male. The landing zone was Zone 2 TEVAR in 80 patients (86,02%). At the segment aorta covered by Stent graft, the minimum diameter of the true lumen was significantly expanded, the maximum diameter of the false lumen tended to be reduced. However, the maximum descending thoracic artery diameter did not change significantly after the procedure, but only decreased significantly after 6 months of TEVAR, with p < 0.05. However, the segment of aorta uncovered by Stent graft, there was little change in the false lumen after TEVAR. The length of complete false luminal thrombosis increased over time (128.7 cm right after TEVAR and 132 cm after 12 months). Multivariate logistic regression showed that coverage aortic length >250 mm (Odds ratio: 3,78; p=0,008) was associated with significantly increased false lumen thrombosis (p<0.05). Conclusions: TEVAR in patients with acute Stanford B aortic dissection promotes aortic remodeling including enlargement of the true lumen and the promotion of complete thrombosis of the false lumen. This remodeling occurred early after the intervention and continued after a follow-up period of up to 12 months. Coverage aortic length >250 mm was associated with significantly increased false lumen thrombosis. Studies with longer follow-up are needed to evaluate long-term aortic remodeling after TEVAR.
