Study On The Characteristics Of Stanford Type B Aortic Dissection And Aortic Remodeling After TEVAR

Objective: To investigate the changes of the location,size and number of Stanford type B aortic dissection(AD)ruptures and the volume and diameter of the true and false lumen after thoracic endovascular aortic repair(TEVAR),and to study the correlation between the corresponding variables.Methods: From August 2014 to December 2020,we collected 82 patients who were diagnosed as type B aortic dissection and underwent endovascular repair in our hospital,sorted out their clinical and imaging data,and made statistical and retrospective analysis.The patients were divided into thoracic group(n=28)and abdominal group(n=50),and the thoracic aorta group(n = 4).The clinical and preoperative and postoperative imaging data of the two groups were compared.The changes of true and false lumens,false lumen thrombosis,total lumen volume and diameter from the root of CTA’s autonomic artery to bilateral iliac arteries were evaluated.The relationship between the location,size,number of the rupture and the effect of aortic remodeling after surgery was analyzed.Result: 1.At 1 week after operation,the number of thoracic ruptures was positively correlated with the volume of false lumen(P = 0.049,P < 0.05).It was negatively correlated with the diameter of the true cavity at the T1 level,and the rest were not correlated.The number of ruptures in the abdominal segment was negatively correlated with the volume of the true lumen and not correlated with the volume of the false lumen.The number of abdominal ruptures was negatively correlated with the diameter of the true lumen and positively correlated with the diameter of the false lumen.The maximum diameter of the rupture was positively correlated with the volume of the false lumen in the thoracoabdominal segment,but not with the volume of the true lumen.The maximum diameter of the rupture was negatively correlated with the true cavity diameter of A1 segment,and positively correlated with the false cavity diameter of T2,T3,A1 and A3 segments.2.At 3 months after operation,the number of thoracic ruptures was only related to the volume of false lumen,but not to the volume of true and false lumen.The number of abdominal ruptures was negatively correlated with the volume of the abdominal true lumen and positively correlated with the volume of the abdominal false lumen.The number of ventral breaks was negatively correlated with the diameter of the true cavity corresponding to A2 and A3,positively correlated with the diameter of the false cavity,and not correlated with the diameter of the true and false cavity corresponding to A1.The maximum diameter of the tear was negatively correlated with the true lumen volume of the abdominal segment and positively correlated with the false lumen volume of the abdominal segment,and the correlation with the change of the true lumen volume was greater than that of the false lumen.The maximum diameter of the break is negatively correlated with the diameter of the true cavity corresponding to A2 and A3,and positively correlated with the diameter of the false cavity.Conclusions: 1.The maximum diameter of the rupture has a great influence on the volume of the thoracic and abdominal false lumen,and has little effect on the volume of the true lumen.When there is a large rupture at the distal end(dissection involving the celiac trunk and the infrarenal abdominal aorta),it is not conducive to positive aortic remodeling.2.The number of aortic tears has a great influence on the volume of thoracic false lumen,abdominal true lumen and the diameter of abdominal true and false lumen.Multiple tears in the thoracic segment are not conducive to the positive remodeling of the distal abdominal aorta.Multiple tears in the abdominal segment(especially in the lower renal abdominal aorta)are beneficial to the positive remodeling of the aorta,which is a protective factor.