Morphometric Aortic Remodeling and Mid-Term Outcomes After TEVAR for Acute Stanford Type B Aortic Dissection: A Single-Center Retrospective Cohort Study

Objectives: This study aimed to evaluate the impact of thoracic endovascular aortic repair (TEVAR) on aortic remodeling using CT angiography-based morphometric measurements and to examine associated mid-term clinical outcomes in patients with acute Stanford type B aortic dissection. Methods: This retrospective, single-center observational cohort study included 33 consecutive patients who underwent TEVAR for acute Stanford type B aortic dissection between January 2020 and January 2025. Preoperative and postoperative true lumen (TL), false lumen (FL), and descending aorta (DA) diameters were compared using paired t-tests after Shapiro–Wilk normality testing. Endoleak, reintervention, FL thrombosis, and mortality were analyzed. Univariable analyses identified factors associated with endoleak and reintervention. Spearman’s correlation assessed factors associated with morphometric remodeling response. Results: All 33 patients had acute Stanford type B dissection (mean time to intervention: 2.73 ± 3.86 days). Among 33 patients (81.8% male; mean age 53.6 ± 12.1 years), mean follow-up was 4.08 ± 1.66 years. TEVAR induced a significant aortic remodeling response: TL diameter increased from 9.55 ± 5.91 mm to 28.30 ± 5.49 mm (+18.76 ± 8.83 mm; p < 0.001) and FL diameter decreased from 33.39 ± 6.76 mm to 11.48 ± 8.97 mm (−21.91 ± 9.53 mm; p < 0.001), while DA diameter remained stable (42.94 ± 6.90 vs. 42.03 ± 9.46 mm; p = 0.323). Complete FL thrombosis was achieved in 19 patients (57.6%). Endoleak occurred in nine patients (27.3%); Zone 2 landing was significantly associated with endoleak (54.5% vs. 13.6%, p = 0.033). Secondary intervention was required in 13 patients (39.4%). Overall mortality was 12.1%. Narrower preoperative TL was strongly associated with greater TL expansion (Spearman r = −0.724, p < 0.001); longer stent–graft coverage was associated with greater TL gain (r = +0.522, p = 0.002). Conclusions: TEVAR induced clinically meaningful aortic remodeling in acute Stanford type B dissection without progressive aortic enlargement. A narrower baseline TL and longer stent–graft coverage were associated with greater remodeling benefit. Zone 2 deployment was significantly associated with higher endoleak rates, underscoring the value of careful preprocedural planning and systematic long-term imaging surveillance.