Comparison of aortic remodelling after conservative treatment or thoracic endovascular repair in type B dissections

Abstract

OBJECTIVES Our aim was to compare aortic remodelling in type B dissections after thoracic endovascular aortic repair (TEVAR) or conservative treatment. METHODS We conducted a retrospective analysis of computed tomography (CT) data sets at dissection onset and at the last follow-up in a group with conservative (group A) and TEVAR treatment (group B). An additional analysis of the preoperative CT images was performed in patients from group A, who were converted to TEVAR during follow-up. Diameters and lengths of all aortic segments were measured and growth rates were calculated. RESULTS We included 74 patients: 50 patients in group A (follow-up time: 1625 ± 209 days) and 24 patients in group B (follow-up time: 554 ± 129 days). The mean aortic diameter growth rate was significantly higher in group A than in group B in the mid-descending aorta (A: +7 mm/year; B: −4 mm/year; P = 0.003). Length growth difference was only present in the abdominal aortic segment and was more pronounced in group A (+2 vs ±0 mm/year; P = 0.009). The conversion rate from conservative treatment to TEVAR was 36% (n = 18). A false lumen diameter of >22 mm at baseline was associated with a higher rate of conversion (P = 0.036). After conversion, the mean growth rate in the proximal descending and mid-descending aorta decreased from preoperative +11 and +18 mm/year to postoperative −9 and −14 mm/year, respectively (P < 0.001). CONCLUSIONS In acute type B dissections, TEVAR stops aortic enlargement in the thoracic aorta, but promotes distal dilatation compared to the conservative treatment group. After conversion to TEVAR in conservatively pretreated chronic type B dissections, a more pronounced diameter decrease in the descending aorta was observed than in patients treated in the acute phase.

Changes in aortic growth rate and factors influencing aneurysmal dilatation after uncomplicated acute type B aortic dissection

“…However, according to our study, we think there is controversy in performing TEVAR for uncomplicated ABAD with small aortic diameter only because of the rapid increase in aortic diameter in the short-term follow-up (even for patients exceeding 0.5 cm at 6 months), and further investigation is needed. Similar to our argument, a recent study has revealed that after conversion to TEVAR in conservatively pretreated chronic type B dissections, a more pronounced decrease in the diameter of the descending aorta than in patients treated in the acute phase is observed [ 23 ].…”

Intramural hematoma in the proximal sealing zone of the thoracic endovascular aneurysm repair: frequency and safety in acute and subacute type B dissections

“…Regarding the aortic diameter regression after TEVAR, the IMH group showed significantly better remodeling. Our previous works described a better diameter remodeling of subacute/chronic dissections than of those treated in the acute phase, which may be an explanation due to the higher rate of subacute dissections in the IMH group ( 26 ).…”

Changing Management of Type B Aortic Dissections

“…While malperfusion is a problem predominantly confined to the hyperacute and acute phases (ie, up to 14 days), it has been observed that remodeling (true lumen expansion and false lumen regression) of the aorta after TEVAR occurs almost exclusively in the segment that is covered by the endograft. [15][16][17][18][19] In addition, temporal changes in the structure and compliance of the dissection membrane have an important impact on long-term success.…”