Retrospective Study Of Aortic Remodeling After Treating Non-acute Stanford B Aortic Dissection With Tapered Stent Gaft Versus Tubing (Non-tapered) Stent Graft

Objective:According to comparison of aortic remodeling and clinical follow-up material after treating Non-acute Stanford B aortic dissection with tapered stent gaft versus tubing(non-tapered)stent graft,we estimate whether there is an advantage of tapered stent gaft.Methods:The data of 30 patients with type B aortic dissection treated from January 2010 to August 2015 were retrospectively analyzed.Of the patients,12 cases underwent TEVAR by tapered stent graft,and 18 cases receiverd TEVAR by tubing stent graft.Accoding to follow-up CTA data of true and false lumen area in levels of aortic isthmus,distal stent,mid thoracic descending aorta,diaphragm level,renal artery,and volume of a segment(aortic isthmus level to renal artery level),then analysis preoperative and postoperative corresponding area parameter and volume parameter change the two groups.Result:The operative success rate was 100%for both group,Indications were postoperative death in 1,distal stent graft induced new entry(SINE)in 1.no postoperative complications such as paraplegia,stroke occurred.In using tepered stent-graft group,true lumen area(Pre vs.Post):aortic isthmus level[0.4(0.2,1.0)vs.0.8(0.5,1.3)P<0.05],distal stent[0.3(0.2,0.4)vs.0.4(0.3,0.7)P<0.05],mid thoracic descending aorta true lumen[0.2(0.1,0.4)vs.0.4(0.2,0.8)P<0.05],false lumen area(Pre vs.Post):aortic isthmus level[0.9(0.1,1.2)vs.0(0,1.7)P<0.05],distal stent[0.6(0.3,1.3)vs.0(0,0.7)P<0.05],mid thoracic descending aorta[0.6(0.3,1.2)vs.0(0,0.5)P<0.05].In using tubing stent-graft group,true lumen area(Pre vs.Post):aortic isthmus level[0.5(0.2,0.8)vs.0.9(0.6,1.2)P<0.05],distal stent[0.3(0.1,0.4)vs.0.6(0.3,6.5)P<0.05],mid thoracic descending aorta[0.3(0.1,0.4)vs.0.5(0.3,1.0)P<0.05],false lumen area(Pre vs.Post):aortic isthmus level[0.7(0,3.3)vs.0(0,0.2)P<0.05],distal stent false lumen[0.5(0,1.3)vs.0(0,1.9)P<0.05],mid thoracic descending aorta false lumen[0.5(0,1.1)vs.0(0,0.8)P<0.05].Tapered stent-graft group true lumen volume(Pre vs.Post):[59.0(35.4,78.6)vs.79.1(63.1,197.2)P<0.05],Tapered stent-graft group false lumen volume(Pre vs.Post):[130.9(66.6,239.3)vs.33.6(1.0,150.2)P<0.05],tubing stent graft group truelumen volume(Pre vs.Post):[61.8(29.4,87.0)vs.106.2(79.7,184.9)P<0.05],tubing stent-graft group false lumen volume(Pre vs.Post):[110.3(42.2,205.9)vs.12.9(0,76.5)P<0.05].Compare with tapered stent-graft group,dilatation rate of distal stent(140%±90%vs.60%t60%P<0.05)and mid thoracic descending aorta true lumen area[100%(20%,350%)vs.50%(-10%,290%)P<0.05]has more significantly change in tubing stent-graft group.Conclusion:1?In the proximal thoracic descending aorta and abdominal aorta,there is no obvious difference between two groups in postoperative aortic remodeling.2?tubing stent has the significant oversizing of the distal stent level area,which could increase the incidence of distal stent graft-indeced new entry,but it needs to be observed for a long time.