Retrospective Analysis Of Clinical Factors Associated With Aortic Remodeling In Patients With Stanford Type B Aortic Dissection After Thoracic Endovascular Aortic Repair

Objective:Acute aortic dissection is a life-threatening aortic condition.Thoracic endovascular aortic repair(TEVAR)is currently the preferred treatment for Stanford acute type B aortic dissection.TEVAR can close the entry tear and immediately reduce false lumen volume,maintain the blood flow into the true lumen and reduce the mortality during the acute phase of aortic dissection in patients.However,the recovery and remodeling of the dissected aorta after TEVAR for acute type B aortic dissection is still unclear,and insufficient clinical attention has been paid to this issue.Aortic remodeling can directly affect the long-term prognosis of patients,so it is important to identify factors influencing aortic remodeling after TEVAR in order to apply active early intervention and further improve patients’ prognosis.Methods:A total of 178 patients with Stanford type B acute aortic dissection from Shenzhen People’s Hospital and Guangdong Provincial People’s Hospital were continuously enrolled from 2011 to 2018,and 100 patients with complete clinical and postoperative follow-up data were finally included and retrospectively analyzed.Relevant data,including baseline(gender,age,drug use,complications,D-dimer),the time from admission to surgery,medicine use,as well as the six different levels(the left subclavian artery,the distal end of the stent-graft,the left ventricle,the diaphragm,the celiac trunk,and the right renal artery)of aortic CTA images obtained before and 6 months after surgery were collected.According to the degree of aortic remodeling,patients were divided into favorable and unfavorable aortic remodeling groups.All statistical analyses were conducted using SPSS software,analysis of variance,and chi-square test was used to compare differences between groups and determine the factors influencing postoperative aortic remodeling.Results:The patients’ blood pressure,age,sex,and medicine use had no significant effect on the postoperative aortic remodeling after endovasculer treatment.There was a significant difference in the intervention methods patients received between favorable and unfavorable aortic remodeling groups.At the levels of the distal end of the stent graft and the diaphragm,there was a significantly higher proportion of patients in the favorable aortic remodeling group received one single stent implantation compared with patients in the unfavorable aortic remodeling group(79.5% vs.53.8% 81.3% vs.56.35% p <0.05).At the levels of the distal end of the stent graft and the diaphragm,The time from admission to endovasculer treatment was also a key factor affecting aortic remodeling,the earlier the TEVAR procedure performed,the better the aortic remodeling(3.4 days vs.4.8 days and 3.6 days vs.4.9 days,p <0.05).At the levels of the celiac trunk and right renal artery,the presence of residual distal entry tears in the abdominal aorta also improved aortic remodeling after TEVAR(85.7% vs.55.1 %,92.0%vs.48.9% p < 0.05)Conclusion:At the levels of the distal end of the stent graft and the diaphragm,intervention methods and the time from admission to surgery can affect the postoperative aortic remodeling.One single sent graft implantation and early surgery are associated with favorable aortic remodeling.At the levels of the celiac trunk and right renal artery,the present of patent distal entry tear is also conducive to aortic remodeling after surgery for aortic dissection.