Risk Factors For Vascular Remodeling After Endoluminal Repair Of Stanford Type B Aortic Dissection

Objective:To compare and analyze the early postoperative false lumen thrombosis in patients with Stanford type B aortic dissection who underwent thoracic endovascular aortic repair(TEVAR).To explore the influencing factors of false lumen thrombosis formation and the changes in diameter and area of the true and false lumen in different planes.Methods: Clinical general conditions,laboratory blood tests,and computed tomography angiography(CTA)data of all patients who underwent standard TEVAR for the first time at the First Affiliated Hospital of Xinjiang Medical University from January 2017 to December2020 were collected.The true and false lumen diameters and areas at the descending aorta maximum diameter,pulmonary artery bifurcation,diaphragm plane,abdominal aorta plane,left renal artery plane,and abdominal aorta bifurcation plane were measured in preoperative and early postoperative CTA images.Patients were divided into two groups: the complete false lumen thrombosis group and the incomplete false lumen thrombosis group.The influencing factors of false lumen thrombosis formation and the changes in diameter and area of the true and false lumen in different planes were analyzed and compared.Results:A total of 81 patients with Stanford type B aortic dissection were included in this study.According to the degree of early postoperative false lumen thrombosis,31 cases were classified into the complete thrombosis group,and 50 cases were classified into the incomplete thrombosis group.The surgery was successful in both groups,with only one case of minor postoperative leakage.The baseline characteristics of the two groups,including age,gender,comorbidities,smoking,drinking,blood pressure,and heart rate,showed no statistical significance.Other influencing factors included Body Mass Index(BMI),eosinophil count,platelet count,hemoglobin,red blood cell count,activated partial thromboplastin time,C-reactive protein,length and type of aortic arch,bird-beak structure,number of tears,and distance between the distal end of the thoracic stent graft and the first reentrant tear.Platelet count and distance between the distal end of the thoracic stent graft and the first reentrant tear were independent risk factors for incomplete false lumen thrombosis(P < 0.05).Conclusion: 1.BMI,eosinophil count,platelet count,hemoglobin,red blood cell count,activated partial thromboplastin time,C-reactive protein,length and type of aortic arch,bird-beak structure,number of tears,and distance between the distal end of the thoracic stent graft and the first reentrant tear are risk factors for incomplete false lumen thrombosis.The distance between the distal end of the thoracic stent graft and the first re-entry tear and platelet count are independent risk factors.2.The true lumen diameter and area above the aortic diaphragm enlarged,and the false lumen diameter and area decreased significantly after TEVAR.The false lumen diameter and area in the abdominal aorta bifurcation segment mostly remained unchanged,and some patients showed an increase.