Comparison On The Effects Of Endovascular Repair Of Acute And Subacute Uncomplicated Stanford Type B Aortic Dissections

Objectives:Comparing the clinical effects and aortic remodeling after Thoracic Endovascular Aortic Repair(TEVAR)for acute and subacute uncomplicated Stanford type B aortic dissection patients to explore the best interventional operation timing.Methods:Combining the preoperative and postoperative clinical outcomes of 72 uncomplicated Stanford B type B aortic dissection patients,including acute group(n=49)and subacute group(n=23),who match diagnostic conditions in Yan An hospital of Kunming medical university between January 2016 and December 2018 were retrospectively analyzed and compared the near and midterm outcomes of both groups.And comparing the Computed Tomographic Angiography(CTA)datum of preoperative and 3,6 and 12 months follow-up,the changes in,the true lumen and false lumen of five different anatomy levels,the maximum diameter of thoracic aortic and the false lumen thrombosis in the different three segments as well as the difference of aortic remodeling in both groups were comprehensively assessed.Results:The technical success rates of interventional operation were 100%in both groups.The rates of perioperative aortic-related complications and hospital mortality were no statistically significant differences(P=0.689,P=0.579).There was an acute patient received reintervention in hospital.The rates of all-cause mortality,aortic-related complications and secondary intervention of near and midterm follow-up were no different(P=0.956,P=0.871,P=0.720).The reasons of reintervention were stent endoleaks after treatment and false lumens continued expansion of remained aortic dissection.The preoperative true lumens diameter of five different anatomy levels were no different in both groups(P=0.370,P=0.051,P=0.867,P=0.550,P=0.081),the false lumens diameter of subacute period were significantly increased than the acute patients in the level of the left renal artery and the abdominal aortic near the bifurcation(P=0.027,P=0.026),the rest of three levels were no different in both groups(P=0.051,P=0.059,P=0.094).Before operation,there were few partial thrombosis of false lumens,but there were no statistically different(P=0.425)in both groups.The preoperative maximum diameters of thoracic aortic in the subacute period were significantly increased than the acute patients(P=0.002).One year follow-up presented a general trend of the true lumen diameters gradually increased,the false lumen diameters gradually decreased.But the changes of true lumen diameters of five levels were no different(P=0.844,P=0.393,P=0.531,P=0.642,P=0.334),there were no statistically significant differences of false lumen diameters of four levels(P=0.079,P=0.747,P=0.702,P=0.233)except the left inferior pulmonary vein of stent segment,the diameter of false lumen decreased significantly in the acute group(P=0.008).The totally absorbed rate of false lumen,the stent segment was the best,and the acute group was higher than that of the subacute group(P=0.016),thoracic aortic beyond the stent comes second,the abdominal aorta was the worst,the false lumen outcomes of distal thoracic aortic and the abdominal aorta were no different(P=0.410,P=0.230).The postoperative maximum diameters of thoracic aortic decreased significantly in the subacute group(P=0.002),but the diameter of subacute group still bigger than acute group.Conclusions:For acute and subacute uncomplicated Stanford type B aortic dissections,the Thoracic Endovascular Aortic Repair(TEVAR)were reliable,the rates of all-cause mortality,aortic-related complications and reintervention of near and midterm follow-up were no significant differences.After TEVAR treatment,the diminution and the thrombus dissolution of false lumen of stent segment in the acute were significantly better than subacute.The preoperative maximum diameters of thoracic aortic in the subacute were evidently increased than the acute,although the postoperative maximum diameters of thoracic aortic decreased significantly in the subacute,the diameter of subacute still bigger than acute.In conclusion,the aortic remodeling of thoracic aortic stent segment in the acute significantly better than that in the subacute,the TEVAR treatment in the acute is secure and the near and midterm outcomes is positive.But the generally poor remodeling of abdominal aorta after intervention needs closely observed follow-up.