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TEVAR of type B aortic dissections favorably affected aortic remodeling
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Thoracic endovascular aortic repair for the treatment of type B aortic dissections yielded increases in true lumen diameter and volume and decreases of false lumen diameter, according to new research.
“This study provides further evidence of the positive impact of thoracic endovascular aortic repair [TEVAR] in patients with a type B aortic dissection,” Fred A. Weaver, MD, MMM, study investigator, told Cardiology Today’s Intervention. “In particular, insight is provided into the impact of TEVAR on abdominal aorta morphology, which is a major factor in late cardiovascular events and the need for additional interventions.”
In the study, which was published in JAMA Surgery, Weaver and fellow researchers from the Keck School of Medicine at the University of Southern California, Los Angeles, performed a retrospective database review, culling 30 patients who underwent thoracic endovascular aortic repair (TEVAR) for type B aortic dissections from 2007 to 2013. They used 3-D imaging software (Vital Images) to obtain measurements of preoperative and postoperative aortic morphologic findings — specifically, volumes and diameters of the aorta — on CT or MRI.
Compared with pre-procedure scans, CT or MRI at a mean of 14.4 months after TEVAR revealed increases in true lumen diameter (31.19 mm vs. 19.5 mm; P<.001) and volume (166.95 mL vs. 77.92 mL; P<.001) and decreases in false lumen diameter (21.92 vs. 29.77 mm; P=.001).
Seventy percent of patients experienced thoracic false lumen thrombosis (FLT), whereas 30% had false lumen patency (FLP). Patients with FLT experienced true lumen volume expansion (180.55 mm vs. 82.07 mm; P<.001) and false lumen volume regression (115.76 mm vs. 161.84 mm; P=.002). Similarly, patients with FLP also had expansion in true lumen volume (128.22 mm vs. 68.23 mm; P<.001) and regression in false lumen volume (198.93 mm vs. 238.64 mm; P=.04), according to data.
TEVAR was associated with increases in true lumen diameter (26.13 vs. 15.67 mm; P<.001) and volume (88.08 mL vs. 54.86 mL; P=.001) in the abdominal aorta among patients with FLT, with no reported change in total abdominal aortic volume.
Furthermore, patients with thoracic FLP had an increase in abdominal aortic volume (221.41 mL vs. 187.24 mL; P=.02).
“Successful TEVAR provides favorable aortic remodeling and is associated with acceptable morbidity and mortality,” Weaver and colleagues wrote. “Our data also suggest that aortic remodeling is most robust in those patients with complete thoracic FLT, but a degree of favorable aortic remodeling is also seen in patients with FLP. However, failure to achieve FLT of the thoracic false lumen appears to negatively influence aortic remodeling of a contiguous abdominal aortic dissection.”
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