title: Endovascular Repair of Acute and Chronic Aortic Type B Dissections: Main Factors Affecting Aortic Remodeling and Clinical Outcome.
abstract: OBJECTIVE
  The aim of this study was to assess factors influencing the clinical outcome and morphological changes of acute and chronic type B aortic dissection after thoracic endovascular aortic repair (TEVAR).
  
  
  BACKGROUND
  Aortic remodeling after TEVAR may be associated with clinical outcome, complications, and endoleak development.
  
  
  METHODS
  Sixty cases of TEVAR for complicated type B acute aortic dissection (AAD) (n = 29) and chronic aortic dissection (CAD) (n = 31) with a minimum follow-up of 3 years were retrospectively reviewed. Using computed tomography images, we assessed true lumen, false lumen, and total aortic short-axis diameters. Six procedural factors were analyzed in relation to aortic remodeling and other outcomes. Analysis of variance was used to compare short-axis, false lumen, and true lumen diameters during the follow-up period. Univariate and multivariate analyses were used to assess the relationship between procedural factors and multiple outcomes.
  
  
  RESULTS
  A total of 100 stent grafts were implanted in 60 consecutive patients with acute aortic dissection (AAD) and CAD. Aortic remodeling consisting of false lumen thrombosis and shrinkage was more prominent in AAD than in CAD, especially within the first 18 months. Of note, the entire aortic diameter increased significantly cephalad to the stent graft in AAD. Only in the AAD group there was increased aortic remodeling related to post-dilation of the stent graft. Type I and II endoleaks occurred in 17 patients (28%); in AAD, embolization of the left subclavian artery after stent graft deployment was significantly associated with a lower risk of endoleak development, but this was not evident in CAD.
  
  
  CONCLUSIONS
  Aortic remodeling and clinical outcome after TEVAR can be influenced by procedural techniques (post-dilation and embolization of the left subclavian artery in patients with acute but not chronic aortic dissection).
authors.affiliation: Department of Radiological Sciences, University of Rome "Sapienza," Rome, Italy. Electronic address: fabrizio.fanelli@uniroma1.it.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Fanelli
authors.affiliation: Department of Radiological Sciences, University of Rome "Sapienza," Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cannavale
authors.affiliation: Department of Interventional Radiology, University College Hospital Galway, Galway, Ireland.
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: O'Sullivan
authors.affiliation: Department of Vascular Surgery, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Gazzetti
authors.affiliation: Department of Radiological Sciences, University of Rome "Sapienza," Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Cirelli
authors.affiliation: Department of Radiological Sciences, University of Rome "Sapienza," Rome, Italy.
authors.forename: Pierleone
authors.initials: P
authors.lastname: Lucatelli
authors.affiliation: Department of Radiological Sciences, University of Rome "Sapienza," Rome, Italy.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Santoni
authors.affiliation: Department of Radiological Sciences, University of Rome "Sapienza," Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001013:Aorta, Thoracic / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D002908:Chronic Disease; D057867:Endoleak / Q000209:etiology / Q000503:physiopathology; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D066253:Vascular Remodeling
keywords: TEVAR; aorta remodeling; aortic dissection; stent graft