Imaging Analysis Of Aortic Remodeling Of Acute Stanford B Aortic Dissection After Endovascular Stent-graft Repair

Objective:Measure the aortic morphological parameters of true lumen and false lumen on pre/post-operative and follow-up images of type B aortic dissections patients(TBAD), combining with clinical materials of follow-up, to determined the durability and effectiveness of thoracic endovascular aortic repair(TEVAR) on TBAD and explore the aortic remodeling and morphological change after TEVAR.Materials and Methods:Collect clinical data and CTA images of48TBAD patients who received TEVAR, calibrate thrombosis area of false lumen(FL), short diameter, long diameter and area of true lumen(TL) and FL in levels of aortic isthmus, mid descending aorta, distal descending aorta, celiac trunk axis, renal artery and distal abdominal aorta. Calculate TL compression index(Ci), effective expanded area(EEA) and effective expanded ratio(EER) and perform statistical analysis combining with48weeks follow-up data.Results:Short diameters of TL were increased2weeks after operation in isthmus and distal descending aorta levels(P<0.01); Short diameters of FL were decreased2weeks after operation in isthmus and mid descending aorta levels(P<0.01); Area of TL and Ci value were increased in all levels while area of FL decreased in descending aorta(P<0.05); EER of renal artery level were positive related to Creatinine decreasing3weeks after operation under Pearson regression analysis(R2=0.7812, P<0.05); Event-free survival rate of distal patent FL group was lower than partial thrombosis group and complete thrombosis group of48weeks follow-up(P<0.05), there was no significant difference between partial thrombosis group and complete thrombosis group. Area of distal FL(HR1.282,95%CI[0.770-2.606], P=0.027) and distal patent FL(HR3.614,95%CI[1.027-6.538], P=0.002) are independent risk factors in prognosis of TBAD after TEVAR.Conclusion:Aortic morphological remodeling plays a important role in prognosis of TBAD after TEVAR treatment, analysis of area provides more accurate and effective information in the process. Area and patency of distal FL are independent risk factors to mortality and requirement of reintervention.