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Aortic Remodeling and Clinical Outcomes in Type B Aortic Dissection According to the Timing of Thoracic Endovascular Aortic Repair

Authors
 Seung-Jun Lee  ;  Woong Chol Kang  ;  Young-Guk Ko  ;  Yeongmin Woo  ;  Chul-Min Ahn  ;  Jong Youn Won  ;  Do-Yun Lee  ;  Sung-Jin Hong  ;  Jung-Sun Kim  ;  Byeong-Keuk Kim  ;  Donghoon Choi  ;  Myeong-Ki Hong  ;  Yangsoo Jang 
Citation
 ANNALS OF VASCULAR SURGERY, Vol.67 : 322-331, 2020-08 
Journal Title
ANNALS OF VASCULAR SURGERY
ISSN
 0890-5096 
Issue Date
2020-08
MeSH
Acute Disease ; Adult ; Aged ; Aneurysm, Dissecting / diagnostic imaging ; Aneurysm, Dissecting / mortality ; Aneurysm, Dissecting / physiopathology ; Aneurysm, Dissecting / surgery* ; Aortic Aneurysm, Thoracic / diagnostic imaging ; Aortic Aneurysm, Thoracic / mortality ; Aortic Aneurysm, Thoracic / physiopathology ; Aortic Aneurysm, Thoracic / surgery* ; Blood Vessel Prosthesis Implantation* / adverse effects ; Blood Vessel Prosthesis Implantation* / mortality ; Chronic Disease ; Endovascular Procedures* / adverse effects ; Endovascular Procedures* / mortality ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications / etiology ; Retrospective Studies ; Risk Factors ; Seoul ; Time Factors ; Time-to-Treatment* ; Treatment Outcome ; Vascular Remodeling
Abstract
Background: The objective of the study was to investigate aortic remodeling and clinical outcomes after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (AD) according to timing of the procedure.

Methods: A total of 87 patients with type B AD who underwent TEVAR at 2 centers were included in this retrospective analysis. Patients were divided into acute/subacute (≤6 weeks, n = 35), early chronic (6 weeks to 1 year, n = 20), and late chronic (>1 year, n = 32) groups according to the timing of TEVAR after symptom onset. Changes in aorta dimensions on serial computed tomography angiograms and clinical outcomes were evaluated.

Results: AD complications were the most common indication for TEVAR in the acute/subacute group, whereas aortic expansion was the main reason in the early and late chronic groups. Maximum total aorta diameter (46.6 ± 10.6 vs. 54.8 ± 9.8 vs. 56.7 ± 10.1 mm, P < 0.001) and false lumen diameter (30.9 ± 11.0 vs. 35.2 ± 12.0 vs. 39.9 ± 13.4 mm, P = 0.013) were smaller in the acute/subacute group than in the early and late chronic groups. At 1-year follow-up, maximum total aorta diameter was decreased in the acute/subacute and early chronic groups and increased in the late chronic group (-4.3 ± 9.3 vs. -5.2 ± 6.9 vs. 2.5 ± 4.6 mm, P < 0.001). Survival free from the major adverse aortic event (death, aortic rupture, or reintervention) at 5 years after TEVAR was lowest in the late chronic group (92.6% vs. 88.2% vs. 73.1%, P = 0.033) but not significantly different between the acute/subacute and early chronic groups (P = 0.680).

Conclusions: TEVAR in the acute/subacute and early chronic phases of type B AD resulted in similar aortic remodeling and clinical outcomes, which were more favorable than those with TEVAR performed during late chronic AD. This finding suggests 1 year after the onset of type B AD symptoms as the upper time threshold for TEVAR to achieve optimal aortic remodeling and safety.
Full Text
https://www.sciencedirect.com/science/article/pii/S0890509620302594
DOI
10.1016/j.avsg.2020.03.022
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Kim, Byeong Keuk(김병극) ORCID logo https://orcid.org/0000-0003-2493-066X
Kim, Jung Sun(김중선) ORCID logo https://orcid.org/0000-0003-2263-3274
Ahn, Chul-Min(안철민) ORCID logo https://orcid.org/0000-0002-7071-4370
Won, Jong Yun(원종윤) ORCID logo https://orcid.org/0000-0002-8237-5628
Lee, Seung-Jun(이승준) ORCID logo https://orcid.org/0000-0002-9201-4818
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
Hong, Sung Jin(홍성진) ORCID logo https://orcid.org/0000-0003-4893-039X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/182615
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