title: Aortic morphologic findings after thoracic endovascular aortic repair for type B aortic dissection.
abstract: OBJECTIVE
  Thoracic endovascular aortic repair (TEVAR) is used in the treatment of type B aortic dissections. Information related to aortic morphologic findings and the condition of the abdominal aorta after TEVAR is limited.
  
  
  OBJECTIVE
  To analyze aortic morphologic findings after TEVAR for type B aortic dissections.
  
  
  METHODS
  After a retrospective database review, the data for 30 patients who underwent TEVAR from January 1, 2007, through December 31, 2013, for type B aortic dissection were analyzed. Imaging software was used to calculate aortic diameters and volumes of the aorta on computed tomography (CT) or magnetic resonance imaging (MRI). Mean follow-up was 14.4 months.
  
  
  METHODS
  We performed TEVAR to cover proximal thoracic aorta tears in patients who underwent acute or chronic type B aortic dissections.
  
  
  METHODS
  Aortic morphologic findings of pre-TEVAR CT or MRI were compared with the most recent findings of post-TEVAR CT or MRI. Frequency of thoracic false lumen thrombosis (FLT) and false lumen patency (FLP) was determined and the effect on post-TEVAR aortic morphologic findings analyzed.
  
  
  RESULTS
  Mean (SD) TEVAR increased true lumen diameter (19.50 [6.92] mm to 31.19 [5.36] mm, P < .001) and volume (77.92 [41.70] mL to 166.95 [69.69] mL, P < .001) and decreased false lumen diameter (29.77 [12.55] mm to 21.92 [12.05] mm, P = .001) on post-TEVAR CT or MRI when compared with pre-TEVAR scans. Seventy percent of patients experienced thoracic FLT; 30% had FLP. True lumen volume expansion and false lumen volume regression occurred in patients with FLT (82.07 [46.95] mm to 180.55 [77.99] mm, P < .001 and 161.84 [106.36] mm to 115.76 [140.77] mm, P = .002, respectively) and FLP (68.23 [21.43] mm to 128.22 [21.46] mm, P < .001 and 238.64 [174.00] mm to 198.93 [120.46] mm, P = .04, respectively). Patients with FLT had increased true lumen diameter (15.67 [6.43] mm to 26.13 [7.62] mm, P < .001) and volume (54.86 [30.52] mL to 88.08 [41.07] mL, P = .001) in the abdominal aorta after TEVAR, with no change in total abdominal aortic volume (161.94 [70.12] mL vs 160.36 [82.11] mL, P = .90). Total abdominal aortic volume significantly increased in patients with thoracic FLP (187.24 [89.88] mL to 221.41 [82.64] mL, P = .02).
  
  
  CONCLUSIONS
  Favorable aortic remodeling of the thoracic aorta occurs after TEVAR for type B aortic dissections in patients with thoracic FLT and FLP. However, failure to achieve thrombosis of the thoracic false lumen negatively influences aortic morphologic findings of the contiguous abdominal aorta.
authors: Division of Vascular Surgery and Endovascular Therapy, CardioVascular Thoracic Institute, Keck School of Medicine, University of Southern California, Los Angeles.
authors: Michael M
authors: MM
authors: Sigman
authors: Division of Vascular Surgery and Endovascular Therapy, CardioVascular Thoracic Institute, Keck School of Medicine, University of Southern California, Los Angeles.
authors: Owen P
authors: OP
authors: Palmer
authors: Division of Vascular Surgery and Endovascular Therapy, CardioVascular Thoracic Institute, Keck School of Medicine, University of Southern California, Los Angeles.
authors: Sung W
authors: SW
authors: Ham
authors: Division of Cardiothoracic Surgery, CardioVascular Thoracic Institute, Keck School of Medicine, University of Southern California, Los Angeles.
authors: Mark
authors: M
authors: Cunningham
authors: Division of Vascular Surgery and Endovascular Therapy, CardioVascular Thoracic Institute, Keck School of Medicine, University of Southern California, Los Angeles.
authors: Fred A
authors: FA
authors: Weaver
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000473:pathology* / Q000628:therapy*; D001012:Aorta, Abdominal / Q000473:pathology; D001013:Aorta, Thoracic / Q000473:pathology*; D017545:Aortic Aneurysm, Thoracic / Q000473:pathology* / Q000601:surgery*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D066253:Vascular Remodeling