Postoperative prognosis and descending aortic remodelling following endovascular aortic repair for acute and no-acute type B aortic dissection.

BACKGROUND

This study evaluates aortic remodelling and clinical outcomes in patients with acute and no-acute type B aortic dissection (TBAD) following endovascular aortic repair (TEVAR).

METHODS

The data of 141 TBAD patients who underwent TEVAR with stent-graft implantation at our institution between September 2018 and May 2023 were retrospectively analysed. Aortic remodelling was assessed by lumen diameter, false lumen thrombosis rate, and morphological parameters (mismatch ratio, oversizing ratio, taper ratio, and radius of curvature). A landmark analysis within a 180-day breakpoint was conducted for crossed survival curves.

RESULTS

The no-acute group demonstrated significantly higher preoperative oversizing (2.22 vs. 3.00, p < 0.001) and mismatch (1.14 vs. 1.21, p < 0.001) ratios. The acute group exhibited a greater cumulative rate of freedom from the composite endpoint (p = 0.010). From baseline to 24 months, both groups exhibited augmented true lumen diameter and attenuated false lumen diameter across all anatomical levels. At the 12-month follow-up, false lumen thrombosis in the descending thoracic aorta decreased following TEVAR in the no-acute group, while it increased in the abdominal aorta in the acute group, indicating better remodelling (21.33% vs. 11.43%, p = 0.005).

CONCLUSION

Patients with no-acute TBAD exhibited an adverse preoperative descending aortic morphology compared with those with acute TBAD. Acute-phase TEVAR presented favourable clinical outcomes and significant aortic remodelling.