Early outcomes of thoracic endovascular aortic repair in treating type B aortic dissection

We evaluated the treatment results and aortic remodeling of Stanford type B aortic dissection （TBAD） following thoracic endovascular aortic repair （TEVAR） to determine the optimal timing to operate. Based on the duration from the onset of TBAD to surgery, 17 patients who underwent TEVAR for TBAD were divided into early （n＝10, TEVAR＜3 months from onset） and late （n＝7, TEVAR≥3 months from onset） groups. True- and false-lumen areas were measured at four levels （A-D） using contrast-enhanced computed tomography before and after TEVAR: A, immediately after the left subclavian artery branching; B, descending aorta at the tracheal bifurcation; C, aortic annulus; and D, diaphragm. The durations from the onset of TBAD to TEVAR were 46±25 days and 7.0±5.3 years in the early and late groups, respectively. No major intraoperative complications were observed in either group. However, the early group had one case of retrograde type A aortic dissection 54 days after TEVAR. In the early group, true-lumen area increased at all levels, except at level A, whereas false-lumen areas decreased at all levels （p＜0.05）. The late group showed no tendencies, except for an increased true-lumen area at level B. A difference in early aortic remodeling was observed—true-lumen area enlargement and false-lumen area decrease were more marked in the early group than the late group. TEVAR is useful when performed early after TBAD onset （within 3 months） and results in good aortic remodeling. In the late phase, the effect might be relatively smaller.