Aortic Remodeling And Main Factors Of Clinical Outcome In Tevar In Acute And Chronic Aortic Type B Dissections

BACKGROUNDAortic remodeling after TEVAR may have differences between acute and chronic aortic dissection. Clinical outcome may be related with surgical factors.OBJECTIVESThe aim of this study was to assess morphological changes and factors which influence the clinical outcome after TEVAR.METHODSThis study contains sixty patients(from 2011-1 to 2015-1)who have type B aortic dissection. 29 of 60 are acute aortic dissection and others are chronic aortic dissection(31).All of them were cured by TEVAR. With a 12-month follow-up, true lumen, false lumen, and total aortic short-axis diameters were assessed by computed tomography angiography or digital subtraction angiography(DSA). During the study, morphological changes and six surgical factors which may be in relation with the aortic remodeling, other clinical outcomes and endoleak development were studied by variance analyses.RESULTSA total of 100 stent grafts were implanted in the 60 patients. During the follow-up, aortic remodeling were more remarkable in AAD than in CAD which includes false lumen thrombosis and shrinkage. What calls for special attention is that the entire aortic diameter of the initial segment of the stent graft increased significantly in AAD. The increased aortic remodeling related to post-dilation of the stent graft only appeared in the AAD group but not in CAD. Type I and II endoleaks occurred in 17 patients(28%). In the AAD group, embolization of the left subclavian artery after stent graft has a close relation with prevention of endoleak and balloon dilation after stent deployment has a close relation with thrombosis in the false lumen. But these were not the reasons of the adverse clinical outcome. These were not found in CAD.CONCLUSIONSAortic remodeling is more remarkable in the acute aortic dissection after TEVAR. Embolization or covering of the left subclavian artery in patients with acute aortic dissection has a close relation with thrombosis in the false lumen and aortic remodeling but no relation with the adverse clinical outcome.