Study Of The Endoleak After TEVAR Of Type B Aortic Dissection And Its Relationship With Aortic Remodeling

Objectives:To study the related conditions and risk factors of endoleak in patients with type B aortic dissection after thoracic endovascular aortic repair(TEVAR),and provide a reference for their rational operation plan.At the same time,to clarify the relationship between endoleak and aortic remodeling by comparing the different of volume of thoracic aorta after TEVAR in two groups,so as to provide a basis for the treatment of patients with endoleak.Methods:Between June 2014 to June 2019,we retrospectively analysis 59 patients with type B aortic dissection who underwent TEVAR at our hospital.They were divided into endoleak group(n=24),and no-endoleak group(n=35)according to whether they had endoleak after TEVAR.The differences of two groups were compared by analyzing the clinical indicators,imaging examinations and operation information.Multivariate logistic regression analyses were used to analyze the risk factors of endoleak after TEVAR.The differences of thoracic aortic remodeling of two groups were analyzed by measuring the volume of the true lumen,false lumen,and total lumen at preoperative,1 week,3 months and 6 months after TEVAR,respectively.Results:24 patients with endoleak include type ? endoleak(n=14),type ?endoleak(n=5)and type V endoleak(n=5).Multivariate logistic regression showed that the radius of curvature of aortic arch(OR=0.618,95%CI:0.416-0.916,P=0.017)and the length of proximal landing zone(OR=0.817,95%CI:0.689-0.968,P=0.019)were the risk factors of type I endoleak in patients with type B aortic dissection after TEVAR.During the 3 months after operation,the volume of true lumen gradually increased and false lumen decreased,and the volume of total lumen decreased at 1 week and then increased slightly(P<0.05).Compared with 3 months after operation.there was no significant change of the volume of other lumens in the two groups(P>0.05)except for the decrease of the volume of false lumen of endoleak group at 6 months after operation(P=0.004).There was no difference of the volume of true lumen,false lumen and total lumen between the two groups before TEVAR(P>0.05).And there was no difference of the volume of true lumen and total lumen between the two groups at different periods after TEVAR(P>0.05).However,the volume of false lumen of endoleak group was larger than that no-endoleak group at different periods after TEVAR(P<0.05).Conclusions:The radius of curvature of aortic arch and the length of proximal landing zone were the risk factors of type I endoleak in patients with type B aortic dissection after TEVAR.The aortic remodeling of thoracic aorta after TEVAR mainly occurred in the early postoperative period.The endoleak after TEVAR mainly affected the volume of the false lumen of the thoracic aorta,but had no effect on the volume of the true lumen and the total lumen of the thoracic aorta.