Late aortic remodeling persists in the stented segment after endovascular repair of acute complicated type B XXXX .

@entity1 @entity101 @entity439 @entity158 @entity1580 @entity2849
OBJECTIVE: Thoracic endovascular aortic repair (TEVAR) for acute complicated type B @entity1580 ( @entity1580 ) promotes early positive aortic remodeling. However, little is known about the long-term effect of TEVAR on the dissected aorta, which is the goal of this study. METHODS: Between August 2005 and August 2009, 31 @entity1 with complicated type B @entity1580 were treated with TEVAR and had >1-year follow-up imaging. Computed tomography angiograms obtained at 1  month, 1  year, and long term (average, 42  months) were compared with baseline scans. The largest diameters of the stented thoracic aorta, stented true lumen, and stented false lumen were recorded at each time point, as were the values in the unstented distal thoracic aorta and the abdominal aorta. Changes over time were evaluated by a mixed effect analysis of variance model of repeated measures. RESULTS: The average age of the cohort was 56  years, and 74% were male. Indications for TEVAR were as follows: 61% malperfusion, 32% refractory @entity101 , 45% impending rupture, and 32% persistent @entity158 ; 58% had more than one indication. All @entity1 were treated in the acute phase within 7  days of the initial presentation. The average length of aorta covered was 19  cm. Observation of the stented segment over time showed that the maximum diameter of the stented thoracic aorta was stable (P  = NS), the diameter of the stented true lumen increased (P  < .001), and the diameter of the stented false lumen decreased (P  < .001); 84% had complete false lumen obliteration across the stented aortic segment. Observation of the uncovered thoracic aorta over time showed that the maximum diameter increased (P  = .014), as did the visceral segment of the aorta (P  < .001). The average growth of the visceral segment was 31% in @entity1 with a patent false lumen vs 3% in those with a thrombosed false lumen (P  = .004). One @entity1 had @entity2849 and required an additional endograft at 18  months. CONCLUSIONS: TEVAR of acute @entity1580 promotes long-term remodeling across the stented segment, with false lumen obliteration in 84% of @entity1 . However, false lumen obliteration beyond the stented segment appears necessary to prevent late @entity439 .
