Key result
A larger initial maximal aortic diameter was significantly associated with an increased risk of reintervention after TEVAR for uncomplicated type B aortic dissection (HR 1.75; 95% CI 1.13-2.69; p=0.011).
Why the study?
Data were scarce regarding the incidence, reasons, potential risk factors, and long-term outcomes of reintervention after TEVAR in uncomplicated type B aortic dissection.
What are the incidence and risk factors for reintervention after TEVAR in patients with uncomplicated type B aortic dissection?
Cohort (n=238)
What are the incidence and risk factors for reintervention after TEVAR in patients with uncomplicated type B aortic dissection?
Hazard Ratio: 1.75 (95% CI 1.13–2.69)
p-value: p=0.011
Reintervention after TEVAR for uncomplicated TBAD occurs in about 11.3% of patients over a mean of 68.6 months, driven by factors like larger initial aortic diameter and excessive proximal landing zone oversizing, but does not significantly impact long-term survival.
Supports closer surveillance after TEVAR for larger initial diameters in TBAD; leaves open whether reduced oversizing lowers reintervention.
Background: Data are scarce regarding the incidence, reasons, potential risk factors, and long-term outcomes of reintervention after thoracic endovascular aortic repair (TEVAR) in patients with uncomplicated type B aortic dissection (TBAD). Methods: Between January 2010 and December 2020, 238 patients with uncomplicated TBAD who received TEVAR were analyzed retrospectively. The clinical baseline data, aorta anatomy, dissection characteristics, and details of the TEVAR procedure were evaluated and compared. A competing-risk regression model was used to estimate the cumulative incidences of reintervention. The multivariate Cox model was used to identify the independent risk factors. Results: The mean follow-up time was 68.6 months. A total of 27 (11.3%) cases of reintervention were observed. The competing-risk analyses showed that the 1-, 3-, and 5-year cumulative incidences of reintervention were 5.07%, 7.08%, and 14.0%, respectively. Reasons for reintervention included endoleak (25.9%), aneurysmal dilation (22.2%), retrograde type A aortic dissection (18.5%), distal stent-graft-induced new entry and false lumen expansion (18.5%), and dissection progression and/or malperfusion (14.8%). Multivariable Cox analysis demonstrated that a larger initial maximal aortic diameter (Hazard ratio [HR], 1.75; 95% Confidence interval [CI], 1.13–2.69, p = 0.011) and increased proximal landing zone oversizing (HR, 1.07; 95% CI, 1.01–1.47, p = 0.033) were the significant risk factors for reintervention. Long-term survival rates were comparable between patients with or without reintervention (p = 0.915). Conclusions: Reintervention after TEVAR in patients with uncomplicated TBAD is not uncommon. A larger initial maximal aortic diameter and excessive proximal landing zone oversizing are associated with the second intervention. Reintervention does not significantly affect long-term survival.
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Cheng et al. (2023) conducted a cohort in uncomplicated type B aortic dissection (TBAD) (n=238). Larger initial maximal aortic diameter was evaluated on reintervention (HR 1.75, 95% CI 1.13-2.69, p=0.011). A larger initial maximal aortic diameter was significantly associated with an increased risk of reintervention after TEVAR for uncomplicated type B aortic dissection (HR 1.75; 95% CI 1.13-2.69; p=0.011).
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