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Original Investigation | Pacific Coast Surgical Association

Aortic Morphologic Findings After Thoracic Endovascular Aortic Repair for Type B Aortic Dissection

Michael M. Sigman, MD1; Owen P. Palmer, MD1; Sung W. Ham, MD1; Mark Cunningham, MD2; Fred A. Weaver, MD, MMM1
[+] Author Affiliations
1Division of Vascular Surgery and Endovascular Therapy, CardioVascular Thoracic Institute, Keck School of Medicine, University of Southern California, Los Angeles
2Division of Cardiothoracic Surgery, CardioVascular Thoracic Institute, Keck School of Medicine, University of Southern California, Los Angeles
JAMA Surg. 2014;149(9):977-983. doi:10.1001/jamasurg.2014.1327.
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Importance  Thoracic endovascular aortic repair (TEVAR) is used in the treatment of type B aortic dissections. Information related to aortic morphologic findings and the condition of the abdominal aorta after TEVAR is limited.

Objective  To analyze aortic morphologic findings after TEVAR for type B aortic dissections.

Design, Setting, and Participants  After a retrospective database review, the data for 30 patients who underwent TEVAR from January 1, 2007, through December 31, 2013, for type B aortic dissection were analyzed. Imaging software was used to calculate aortic diameters and volumes of the aorta on computed tomography (CT) or magnetic resonance imaging (MRI). Mean follow-up was 14.4 months.

Interventions  We performed TEVAR to cover proximal thoracic aorta tears in patients who underwent acute or chronic type B aortic dissections.

Main Outcomes and Measures  Aortic morphologic findings of pre-TEVAR CT or MRI were compared with the most recent findings of post-TEVAR CT or MRI. Frequency of thoracic false lumen thrombosis (FLT) and false lumen patency (FLP) was determined and the effect on post-TEVAR aortic morphologic findings analyzed.

Results  Mean (SD) TEVAR increased true lumen diameter (19.50 [6.92] mm to 31.19 [5.36] mm, P < .001) and volume (77.92 [41.70] mL to 166.95 [69.69] mL, P < .001) and decreased false lumen diameter (29.77 [12.55] mm to 21.92 [12.05] mm, P = .001) on post-TEVAR CT or MRI when compared with pre-TEVAR scans. Seventy percent of patients experienced thoracic FLT; 30% had FLP. True lumen volume expansion and false lumen volume regression occurred in patients with FLT (82.07 [46.95] mm to 180.55 [77.99] mm, P < .001 and 161.84 [106.36] mm to 115.76 [140.77] mm, P = .002, respectively) and FLP (68.23 [21.43] mm to 128.22 [21.46] mm, P < .001 and 238.64 [174.00] mm to 198.93 [120.46] mm, P = .04, respectively). Patients with FLT had increased true lumen diameter (15.67 [6.43] mm to 26.13 [7.62] mm, P < .001) and volume (54.86 [30.52] mL to 88.08 [41.07] mL, P = .001) in the abdominal aorta after TEVAR, with no change in total abdominal aortic volume (161.94 [70.12] mL vs 160.36 [82.11] mL, P = .90). Total abdominal aortic volume significantly increased in patients with thoracic FLP (187.24 [89.88] mL to 221.41 [82.64] mL, P = .02).

Conclusions and Relevance  Favorable aortic remodeling of the thoracic aorta occurs after TEVAR for type B aortic dissections in patients with thoracic FLT and FLP. However, failure to achieve thrombosis of the thoracic false lumen negatively influences aortic morphologic findings of the contiguous abdominal aorta.

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Figure.
Demonstration of Three-Dimensional Imaging of Aortic Volume Calculation

A, Manual circumferential measures result in area calculations. B, The software combines these areas vertically to calculate a columnar volume.

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