Aortic Remodeling and Late Outcomes following Thoracic Endovascular Repair with Bare-Metal Stent Distal Extension among Patients with Complicated Type-B Aortic Dissection.

OBJECTIVES: The aim of this study was to describe the factors affecting mid- and late aortic remodelling following TEVAR with PETTICOAT technique among patients with complicated acute or subacute type B aortic dissection.

METHODS: A retrospective single center study that evaluates clinical and morphological outcomes among 65 consecutive patients. The area and diameter of the true- and false-lumen, overall aortic diameter, as well as false lumen perfusion were trended.

RESULTS: Concomitant direct visceral artery stenting was conducted in 32 (49%) patients. There was one (1.5%) postoperative stroke, three (4.6%) patients developed spinal cord ischaemia, two (3%) patients suffered retrograde Type A dissection and two (3%) patients had mesenteric ischaemia despite successful reperfusion, requiring bowel resection. Median post-operative follow-up was 63.1 (IQR is 32.1- 91.8) months. The probability of survival was 96.9% (95% CI 88.3%-99.2%) at 30 days, 93.9% (95% CI 84.4%-97.6%) at 1 year, 78.0 (95% CI 64.2%-87.0%) at 5 years and 72.8% (95% CI at 57.9%-83.2%) at 10 years postoperatively. There was a statistically significant postoperative increase in true-lumen area, diameter, and true-lumen index in all the five aortic levels measured. Complete false lumen (FL) thrombosis at the coeliac trunk, renal arteries and aortic bifurcation levels was observed in 47%, 15% and 24% of patients at midterm (6-15 months) and 29%, 21% and 29% on late (later than 21 months) CT angiograms. Persistent FL perfusion at the coeliac level was associated with a larger extent of late aortic growth (p = 0.042), and was in the majority of cases caused by iliac re-entries either alone (28.57), or in combination with visceral and lumbar (28.57%) or distal aortic (10.71%) re-entries. A larger abdominal aortic diameter at midterm was associated with an increased probability of distal aortic reinterventions (HR 7.26, 95% CI 2.41-21.9, p < 0.001).

CONCLUSIONS: Persistent FL perfusion of the distal aorta at midterm following TEVAR with PETTICOAT technique among patients with acute and subacute type B dissection, is caused mainly by illiac, visceral, lumber and distal aorta re-entries. Patients with persistent FL perfusion have an increased risk for aortic aneurysmal growth on late follow-up.