Impact of aortic coverage length on thoracic and abdominal aortic remodeling following TEVAR for type B dissections
Narek Veranyan, Gregory Magee, Eric Kuo, Fred A. Weaver, Sung W. Ham, Fernando Fleischman, Vincent L. Rowe, Sukgu M. Han.
Keck Hospital of University of South California, Los Angeles, CA, USA.
Thoracic endovascular aortic repair (TEVAR) is widely used to treat type B aortic dissection (TBAD). Compared to medical treatment alone, TEVAR induces favorable aortic remodeling, as indicated by false lumen thrombosis (FLT) and stabilization of aortic diameter. The optimal length of TEVAR coverage needed to induce favorable thoracic and abdominal aortic remodeling remains uncertain. This study aims to assess the impact of TEVAR coverage length on FLT and dilation of the thoracic and abdominal aortic segments.
Consecutive patients who underwent TEVAR for TBAD from December 2006 to June 2016 were reviewed. Centerline reconstruction of postoperative computed tomography angiography (CTA) was performed to determine FLT, TEVAR coverage length (LCOV), and length of uncovered thoracic aorta (LUC). LUC was defined as the centerline distance between the distal extent of the stent graft to the celiac artery origin. Changes in thoracic (αT) and abdominal (αA) aortic diameters were calculated from preoperative and most recent follow-up CTAs. . Univariate and multivariate logistic regression analyses were performed to evaluate factors associated with FLT and greater than 5mm growth of the thoracic and abdominal aorta.
Sixty one patients who underwent TEVAR for TBAD were analyzed. Mean LCOV and LUC were 157.6±35.8mm and 117.8±5.7, respectively. Overall, complete thoracic and abdominal FLT rates were 33% and 13% respectively. On the average, there was a significant abdominal aortic expansion (αA=0.39cm; 95% CI: 0.21~0.57), whereas thoracic aortic diameter appeared stable(αT=0.19cm; 95% CI: 0.08~0.45). Longer LCOV and shorter LUC were associated with higher thoracic FLT in univariate and multivariate analysis (Fig) but neither were associated with greater than 5mm growth of the abdominal aorta. Additionally, there was no association between thoracic FLT and abdominal aortic growth.
Longer TEVAR coverage and distal landing zone closer to the celiac are independently associated with thoracic FLT, but do not appear to prevent abdominal
aortic growth. These findings suggest that the dissected abdominal aorta may remodel independently from the treatment of the thoracic aorta.
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