Correlation Between Preoperative Thoracic Side Branches Arising From False Lumen (tSAFL) And Aortic Remodeling After TEVAR In Debakey â…¢b Aortic Dissection

Background—Thoracic endovascular repair (TEVAR) has become an increasingly utilized therapy for patients with aortic dissection. Some successfully treated dissection patients may experience distal thoracic aortic enlargement (DTAE). The correlation between preoperative thoracic side branches arising from false lumen (tSAFL) and postoperative DTAE has been scarcely described.Methods and Results—Between January 2011 and December 2013,73 patients who were treated with standard thoracic endovascular repair for Debakey Ⅲb dissection were retrospectively analyzed. Serial computed tomographic angiography images were obtained to evaluate the number of preoperative tSAFL and the changes of aortic diameter during postoperative period. Based on the anatomic feature of tSAFL, a new classification system, name as Kuoger classification system, was developed for categorization of Debakey Ⅲb dissection. The median imaging follow-up time was 12.2 months (Q1-Q3,4.7-27.5months). Seventeen patients experienced DTAE and the other 53 patients achieved relative stable distal thoracic aorta. Cumulative DTAE rate was 0.17,0.21,0.33 and 0.33 (95% CI,0.16-0.52) at 6,12,24 and 36 months, respectively. Multivariate Cox proportional hazards regression analysis identified tSAFL was a independent predictor of DTAE ((hazard ratio [HR]:1.46 [1.22-1.74]; P<0.01). In addition, compared with Kuoger I dissection, the adjusted HRs of DTAE associated with Kuoger Ⅱ and Kuoger Ⅲ dissection was 4.91 (95% CI,0.91-26.51; P=0.07) and 11.30 (95%CI,1.80-70.91; P=0.01), respectively.Conclusions—More preoperative tSAFL and Kuoger Ⅲ dissection protend DTAE after standard TEVAR. These findings can help to identify patients at greater risk of DTAE after standard TEVAR and enlighten the necessity of a specific approach to precisely seal tSAFL within false lumen.