Mid-term Outcomes of Thoracic Endovascular Aortic Repair (TEVAR) in Acute Complicated Type B Aortic Dissection: A Comprehensive Analysis of Aortic Remodeling Patterns.

Abstract

Purpose: This study provides a comprehensive analysis of the clinical outcomes associated with endovascular treatment for acute complicated type B aortic dissection, with a focus on the complex process of aortic remodeling.

Materials and methods: We conducted a retrospective investigation using data extracted from the Songklanagarind Hospital database between January 2010 and January 2022. Electronic medical records of patients who underwent thoracic endovascular aortic repair (TEVAR) for acute complicated type B aortic dissections were reviewed. The analysis focused on in-hospital outcomes, overall survival, aorta-related survival, reintervention-free survival, and changes in aortic lumen diameter to assess aortic remodeling.

Results: Over the study period, 32 patients with acute complicated type B aortic dissections underwent TEVAR. The in-hospital mortality rate was 9.4%, with complications occurring in 21.9% of patients. Temporary acute kidney injury was observed in 9.4% of the cases, wound bleeding in 6.3%, pneumonia in 6.3%, and permanent spinal cord ischemia in 3.1%. Re-intervention was necessary in 6.3% of cases. The overall survival rates at 6 months, 1 year, 3 years, and 6 years were 78%, 75%, 65%, and 44%, respectively. Aorta-related survival rates were 87%, 87%, 83%, and 75% at the corresponding time intervals. The reintervention-free survival rates were 96%, 96%, 71%, and 71%, respectively. Survival analysis revealed that patients with ideal aortic remodeling experienced the most favorable outcomes, whereas those with undesirable aortic remodeling exhibited the least favorable survival. Notably, undesirable pattern of aortic remodeling emerged as a singular factor with a statistically significant influence on predicting survival (hazard ratio 4.37, P-value=0.021).

Conclusion: TEVAR resulted in favorable aorta-related survival outcomes. Notably, the identification of changes in aortic lumen diameter alongside false lumen thrombosis, encapsulated within the framework of aortic remodeling patterns, has emerged as a robust predictor of post-TEVAR survival outcomes.