title: Aortic Remodeling After Endovascular Repair of Complicated Acute Type B Aortic Dissection.
abstract: BACKGROUND
  Thoracic endovascular aortic repair (TEVAR) is the optimal therapy for complicated acute type B aortic dissection (aTBAD). This study examined clinical outcomes and aortic remodeling parameters after TEVAR for patients with complicated aTBAD.
  
  
  METHODS
  From January 2012 to December 2015, 51 patients underwent TEVAR for complicated aTBAD. Preoperative and postoperative imaging studies were analyzed for sizes of the true lumen (TL) and false lumen (FL) and for the FL thrombosis status at five locations in the thoracic and abdominal aorta.
  
  
  RESULTS
  In-hospital and 1-year mortality rates were 3.9% and 5.8%, respectively. The incidence of stroke and paraparesis were 3.9% and 5.8%, respectively. In DeBakey 3a patients, TEVAR resulted in complete FL thrombosis and/or obliteration in 73% of patients. In DeBakey 3b patients, TEVAR resulted in complete FL thrombosis and/or obliteration in 100% of patients in the proximal descending thoracic aorta and 78% in the midpoint of the descending thoracic aorta. The infrarenal FL remained patent in 78% of patients. TEVAR stabilized the size of the proximal descending thoracic aorta (pre-TEVAR 43 ± 9 mm vs post-TEVAR 39 ± 7 mm; p = 0.07). However, significant aortic expansion was observed in all other downstream aortic segments. TEVAR resulted in a significant expansion in the TL volume (pre-TEVAR 99 ± 51 cm3vs post-TEVAR 185 ± 70 cm3; p < 0.01) and total aortic volume (pre-TEVAR 314 ± 97 cm3vs post-TEVAR 391 ± 120 cm3; p = 0.02) while inhibiting expansion of FL volume (pre-TEVAR 215 ± 67 cm3vs post-TEVAR 204 ± 79 cm3; p = 0.91).
  
  
  CONCLUSIONS
  TEVAR for complicated aTBAD results in low 30-day and 1-year mortality rates, with higher reintervention rates than observed with open operations. TEVAR is effective in thrombosing and stabilizing the size of the thoracic FL. The abdominal aortic FL remains patent and must be carefully scrutinized for long-term aneurysm formation.
authors.affiliation: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia. Electronic address: bleshno@emory.edu.
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Leshnower
authors.affiliation: Division of Vascular and Endovascular Therapy, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Yazan M
authors.initials: YM
authors.lastname: Duwayri
authors.affiliation: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Edward P
authors.initials: EP
authors.lastname: Chen
authors.affiliation: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Chun
authors.initials: C
authors.lastname: Li
authors.affiliation: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Carl A
authors.initials: CA
authors.lastname: Zehner
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Jose N
authors.initials: JN
authors.lastname: Binongo
authors.affiliation: Division of Vascular and Endovascular Therapy, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Veeraswamy
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation / Q000706:statistics & numerical data; D066253:Vascular Remodeling