Abstract 2133: Aortic Remodelling After Endovascular Stent-Graft Placement for Type B Dissection- Insights from 3-D Computed Tomography
Background: Endovascular stent-graft repair (EVAR) for type B aortic dissection (AD) has shown encouraging clinical results. Detailed analysis of stent-graft induced aortic reconstruction is however lacking so far.
Methods: Ten patients (60±13 years, 9 male) who underwent EVAR for type B-AD with stent-grafts were included. All patients underwent computed tomography (CT) before the procedure, after EVAR, and at follow-up (mean: 10.5±4.8 months). For all CTs, volumes of the whole aorta, true (TL) and false lumen (FL) were quantified from the origin of the left subclavian artery down to the aortic bifurcation using a software package (Analyze, Mayo Clinic, USA). Comparisons of aortic volumes were made using the Wilcoxon signed rank test.
Results: EVAR resulted in a significant increase of TL volume (128±57 ml to 154±49 ml, p=0.028), which was further increased in follow-up (210±74 ml, p=0.005 vs. baseline).The volume of FL showed a decrease from 220±107 ml at baseline to 122±68 ml after EVAR and 81±61 ml at follow-up (p=0.007). The overall aorta showed a non-significant increase over time (383±148 ml at baseline to 399±147 ml after EVAR to 408±151 ml at follow-up, p=0.086). In this regard, the abdominal aorta showed a pronounced increase (71±25 ml to 85±46 ml, p=0.009) while the volume of the thoracic aorta remained stable (311±126 ml to 322±114 ml, p=0.386).
Conclusion: The study demonstrates that EVAR for type B-AD results in a significant increase of TL volume which is not only limited to an acute effect of EVAR but also extends into the follow-up period. Despite this aortic remodelling, the overall volume of the descending aorta shows a steady increase, in particular of the abdominal aorta.