Preoperative distal aortic diameter is a significant predictor of late aorta-related events after endovascular repair for chronic type B aortic dissection

Gen Thorac Cardiovasc Surg. 2020 Oct;68(10):1086-1093. doi: 10.1007/s11748-020-01318-1. Epub 2020 Feb 20.


Objectives: Long-term therapeutic effects of thoracic endovascular aortic repair (TEVAR) for chronic type B aortic dissection remain controversial. This study aimed to evaluate the possible predictors of late aortic rupture and re-interventions after TEVAR.

Methods: We retrospectively reviewed the operative outcomes of 40 patients who underwent TEVAR for chronic type B aortic dissection at Kyushu University Hospital. During a mean follow-up period of 39.2 months, we assessed aortic morphology via computed tomography and then employed a multivariable Cox regression analysis in an attempt to identify the predictors of late aorta-related events.

Results: The early success rate of TEVAR was 100%. During the follow-up, however, three patients died from aortic rupture. Eight patients required aortic re-intervention, including thoraco-abdominal aortic graft replacement, repeated TEVAR, total arch replacement and EVAR. Multivariable Cox regression analysis revealed that the preoperative maximum distal aortic diameter was a significant predictor of late aorta-related events. The cutoff value of the distal aortic diameter was 40 mm. Freedom from aorta-related events was 94.6% at 1 year and 78.3% at 3 years. The survival rate was not significantly different despite the re-intervention.

Conclusions: TEVAR is an effective treatment for chronic type B dissection, with acceptable mid-term results. The preoperative distal aortic diameter is a significant risk factor for late aorta-related events. When the maximum distal aortic diameter is ≥ 40 mm, a therapeutic strategy should be developed taking into consideration the possible need for aortic re-intervention.

Keywords: Chronic type B dissection; Re-intervention; Staged operation; TEVAR.

MeSH terms

  • Aged
  • Aorta / anatomy & histology
  • Aortic Aneurysm, Thoracic / diagnostic imaging
  • Aortic Aneurysm, Thoracic / pathology
  • Aortic Aneurysm, Thoracic / surgery*
  • Aortic Dissection / diagnostic imaging
  • Aortic Dissection / surgery*
  • Aortic Rupture / etiology
  • Blood Vessel Prosthesis Implantation* / adverse effects
  • Endovascular Procedures* / adverse effects
  • Female
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / etiology
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • Survival Analysis
  • Tomography, X-Ray Computed