Aortic Remodeling After Thoracic Endovascular Aortic Repair In Patients With Acute Type B Aortic Dissection

Objective: To study the changes of the area oftrue lumen,false lumen and arteriae aorta at different levels,and to compare and analyze the remodeling of aorta in acute and subacute phases.Discuss the difference of aortic remodeling after thoracic endovascular aortic repair in patients with acute and subacute type B aortic dissection,and analyze the influencing factors of aortic remodeling.Methods: From September 2018 to December 2020,39 patients with type B aortic dissection were admitted to the second department of subsidiary Hospital of Dali University and received thoracic endovascular aortic repair.Collect basic information: age,sex;history of smoking;complications: hypertension,cerebrovascular accidents;clinical and imaging data of preoperative and postoperative follow-up.The changes of the diameter of the true lumen and false lumen in different layers were collected before and after operation,and the changes of the area of the true lumen,false lumen and arteriae aorta at different layers were studied.To compare and analyze the situation of aortic remodeling in acute phase and subacute phase,and analyze the influencing factors of aortic remodeling.Results: A total of 39 patients with type B aortic dissection were included in this study,1 died of systemic organ failure during perioperative period,and 38 patients were followed up(26 in acute group and 12 in subacute group).The age range is 31-76 years,the median age is 52.5years,and the ratio of men to women is 3.2:1,most of which are male patients.In this study,31 patients(81.5%)were complicated with hypertension,and only 20 patients(52.6%)were previously diagnosed with hypertension.Among 38 patients with type B aortic dissection,30(78.9%)of the patients with false lumen involved the abdominal aortic segment,and 11(28.9%)of the patients with aorta abdominalis segment branches had false lumen blood supply.All patients were operated successfully.The diameter of true lumen in the carina of trachea plane,the diaphragm plane,the upper margin plane of the celiac trunk artery opening(p<0.001,p=0.002,p=0.036),and the area(p=0.021,p=0.03,p=0.021)all increased significantly after,but the increase amplitude decreased in turn.Carina of trachea plane true lumen increased significantly than other plane postoperative than before.B efore and after the operation,there was no statistical difference in the true lumen diameter(p=0.132)and area(p=0.987)of the bifurcation plane of the abdominal aorta true lumen.The diameter(p<0.001)and area(p=0.002)of the plane false lumen of the carina of trachea plane were reduced the most,followed by the diameter(p<0.001)and the area(p<0.001)of the diaphragm plane.There was no significant change in the diameter of the false lumen(p=0.307,p=0.551)and area(p=0.307,p=0.884)before and after operation at the upper margin plane of the celiac trunk artery opening and the bifurcation plane of abdominal aorta.After operation,the effect of carina of tracheaplane arteriae aorta remodeling was better than that of diaphragm plane and abdominal dry plane,and the false lumen of thoracic aorta segment tended to be absorbed completely(p=0.007),and the acute group of false lumen thrombus absorption was better than that of subacute group.Multiple rupture is risk factors that are not conducive to aortic remodeling in the diaphragm plane and the abdominal dry plane(p=0.026,p=0.002)of the diaphragm.Conclusions :1.After TEVAR,the diameter and area of the true lumen were gradually increased.The diameter and area of the false lumen in the middle part of the stent decreased significantly after TEVAR,and the decrease amplitude became smaller in the distal end of the stent,but remained unchanged in the abdominal aorta,and increased in some patients.2.After TEVAR,the remodeling effect of thoracic aortic segment was the best,and the acute stage was better than the subacute stage,the stent is followed by the distal thoracic aorta.In both acute and subacute phases,aortic remodeling was poor at the upper edge of celiac trunk opening and the bifurcation plane of abdominal aorta.3.Multiple rupture is a risk factor for benign remodeling of diaphragm plane and upper edge of abdominal dry opening.