Predictors of early adverse events and remodeling after thoracic endovascular aortic repair for type B aortic dissection

BACKGROUND: To identify factors associated with early adverse events and aortic remodeling following thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). METHODS: A dual-center retrospective analysis was performed on 33 consecutive patients who underwent first-time TEVAR for acute and subacute TBAD between October 2022 and September 2024. Patients with residual or recurrent type A dissection, previous arch reconstruction, staged thoracoabdominal repair, in-situ fenestration, or candy-plug techniques were excluded. Demographics, procedural details, and outcomes were analyzed according to Society for Vascular Surgery (SVS) reporting standards. Univariate analysis was used to identify predictors of adverse events, positive remodeling, reintervention, and mortality. Primary outcomes included technical success and 30-day results, while secondary outcomes encompassed follow-up remodeling, mortality, and reintervention. RESULTS: Technical success was achieved in 97% of cases. Thirty-day mortality and major adverse event (MAE) rates were 6% and 24%, respectively. At a mean follow-up of 13.8±7.2 months, positive aortic remodeling occurred in 73% of patients, and aortic-related reintervention in 21%. On univariate analysis, urgent presentation (P=0.008), complicated dissection (P=0.017), and higher body-mass index (P=0.028) predicted 30-day adverse events, whereas beta-blocker therapy was protective (P=0.034). Persistent false-lumen perfusion at completion, discharge, and six-month imaging was associated with reduced remodeling (P<0.05). Dyslipidemia and persistent false-lumen perfusion correlated with later reintervention. CONCLUSIONS: TEVAR for TBAD achieved high technical success and favourable mid-term outcomes. Urgent or complicated presentations predict early morbidity, whereas sustained false-lumen flow compromises remodeling and increases reintervention risk. Complete false-lumen exclusion and optimal medical therapy are essential for durable results.