Analysis Of The Characteristics And Influencing Factors Of Visceral Artery Remodeling After TEVAR For Complex Stanford Type B Aortic Dissection

Objective: Based on the morphological data of the true and false lumen of each visceral artery level and the beginning of visceral artery at each time point before and after endovascular repair of thoracic aorta,combined with the general condition before the operation and postoperative follow-up data,the characteristics of visceral artery remodeling were summarized.and the related factors were analyzed.Methods: A total of 142 patients who came to our hospital from January2017 to June 2020 and were diagnosed as Stanford B aortic dissection by at least one CTA examination were collected;78 of them were treated with a single endoluminal stent for TEVAR(78/142,55%).Among the 78 people,the dissection involved one or more visceral arteries in 32 people(32/78,41%).A total of 32 indicators of the CAT,SMA,LRA,and RRA origin and the plane of the abdominal aorta where they are located are measured,and the true lumen,false lumen,and thrombus of the false lumen in the preoperative and postoperative time points are recorded.Calculate the "True Lumen Index" and "Thrombus Index" to evaluate the visceral artery remodeling of the test patients from the morphological point of view,and summarize the characteristics of the visceral artery remodeling,and then analyze the related effects factor.Results: 1.A total of 32 unbranched intraluminal stents were implanted in the test patients.The first breach closure rate was 100%.There was no death,acute coronary syndrome,and cerebrovascular adverse events during the perioperative period.No major complications related to stents(such as reverse tearing of the dissection,stent-induced new hair dissection,etc.).During the follow-up period,1 type II endoleak(1/32,3%)and 2 type IV endoleaks(2/32,6%)were found.There were no deaths or other adverse events during the follow-up period.2.After TEVAR intervention,the true lumen diameter of the aorta at each visceral artery level was significantly enlarged,and the false lumen diameter of the aorta at the LRA level was significantly reduced.The true lumen area of the aorta at each visceral artery level was significantly enlarged,and the false lumen area of the aorta at the CAT and the SMA level was significantly enlarged.The true lumen at the beginning of the CAT,the SMA,and the LRA was significantly enlarged,the false lumen of them were significantly reduced,and the thrombus in the false lumen of the SMA and the LRA was significantly increased.The index of aortic true lumen diameter at the CAT level increased significantly;the index of aortic true lumen area of the CAT,the SMA,and the LRA level increased significantly.The index of the aortic false lumen thrombus at the CAT level and the SMA level was increased significantly;the index of the true lumen of the CAT,the SMA,and the LRA was increased significantly.The above changes are most significant within 3 months after surgery.3.The time from onset to operation is negatively correlated with the overall prognosis of visceral artery remodeling.4.For every additional day from onset to operation,the risk of poor visceral artery remodeling increases by 1.198 times.Conclusions: 1.TEVAR treatment has a positive effect on the remodeling of visceral arteries;2.Early surgery is conducive to the expansion of the true lumen of visceral arteries and the thrombosis of the false lumen of visceral arteries.