Clinical follow-up and predictors of re-intervention following thoracic endovascular aortic repair for Stanford type B aortic dissection

OBJECTIVE: This study observed the clinical effect of Thoracic endovascular aortic repair (TEVAR) for Stanford Type B aortic dissection (TBAD) and identified predictors of re-intervention. METHODS: A retrospective analysis was conducted on the clinical data of TBAD patients visiting the People's Hospital of Ningxia Hui Autonomous Region and undergoing TEVAR. Based on illness duration at the time of TEVAR, patients during the subacute or chronic phase were classified into the subacute group and chronic group. The changes in the aorta after the operation and the postoperative complications were evaluated. The risk factors for patients requiring further intervention were analyzed. RESULTS: With a comparable incidence of postoperative complications, the subacute group showed better performance in terms of the false lumen thrombosis status and thrombus complete absorption rate. Postoperatively, the true lumen diameter at the left subclavian artery origin plane and the pulmonary artery bifurcation plane increased, while the false lumen diameter decreased. Multivariate logistic regression analysis showed that tubular graft (OR = 6.782, 95% CI = 1.668-27.582), graft length ≤145 mm (OR = 6.783, 95% CI = 1.623-28.348), postoperative false lumen expansion diameter >5 mm (OR = 6.906, 95% CI = 1.728-27.604), graft oversizing >15% (OR = 26.531, 95% CI = 5.800-121.370), and chronic-phase surgery (OR = 22.378, 95% CI = 2.987-167.637) were risk factors for re-intervention after TEVAR surgery. CONCLUSION: TEVAR treatment for TBAD has certain short-term and mid-term efficacy, but the aortic remodeling effect is poor in patients in the chronic stage. Surgical timing, graft selection and its impact on false lumen expansion are risk factors for re-intervention after TEVAR surgery. Appropriate surgical timing and graft should be selected to avoid re-intervention.