Five-year outcome of provisional extension to induce complete attachment aortic repair for chronic residual aortic dissection DeBakey type I.

Abstract

Objectives: Reintervention for residual aortic dissection DeBakey type I is a complex and controversial topic. Endovascular bare metal stent (BMS) use may be an alternative option for abdominal aorta remodeling, but evidence supporting its efficacy is still limited.

Methods: This study investigated the effects of BMS in the abdominal aorta. Patients who initially underwent emergent surgical procedures, such as ascending aortic grafting, the Bentall procedure, or valve-sparing ascending aortic repair, and later received reintervention surgeries during follow-up, including traditional total arch replacement or hybrid endovascular arch debranching combined with thoracic endovascular aortic repair, were enrolled. Patients were categorized into two groups: a non-BMS group and BMS group. Outcomes were analyzed over a 5-year follow-up period.

Results: A total of 22 patients received a BMS, whereas 22 patients did not. In the abdominal aorta segment, the BMS group had significantly greater true lumen expansion and increased false lumen thrombosis compared with the non-BMS group at 5 years of follow-up (p<0.001^∗ for true lumen expansion; p=0.024^∗ for thrombosis). In addition, positive abdominal aortic remodeling was observed more frequently in the BMS group than in the non-BMS group (5 vs. 0 patients, p=0.048^∗).

Conclusions: During the 5-year observation period, abdominal BMS effectively and consistently promoted true lumen expansion, increased false lumen thrombosis, and resulted in positive aortic remodeling. However, these radiologic improvements did not translate into significant differences in 5-year overall survival or freedom from reintervention. Nonetheless, this approach may be a viable option for abdominal aortic remodeling in the chronic phase.