Landing Zone Remodeling after Endovascular Aortic Repair of Dissected Descending Aorta

Objectives: The aim of this study was to determine the aortic proximal and distal landing zone’s geometry change after thoracic endovascular aortic repair (TEVAR) for acute descending aortic dissection.

Methods: Included are patients who underwent TEVAR for acute descending aortic dissection between 2004 and 2018. Dissection extension, most proximal entry location, proximal and distal landing zones initial geometry and its change at follow-up, and TEVAR-related complications are reported. Median follow-up time was 2.3 (first quartile 0.9, third quartile 4.5) years.

Results: Overall included are 101 patients (93 Type B and 8 non-A non-B dissections, aged 65, first quartile 57, third quartile 74 years old, 29% female). Cardiovascular risk factors included hypertension in 92%, nicotine abuse in 18%, and diabetes mellitus in 9%. Dissection extended down to abdominal aorta in 69% patients. The most proximal entry was located most frequently (58%) in the descending aorta between its first and second quartiles. The initial proximal landing zone diameter was 35 (first quartile 32, third quartile 39) mm, it was dissected in nine patients and its diameter did not change at follow-up. Distal landing zone was dissected in 83% patients with max/min true lumen diameter of 29/22 mm and total aortic diameter of 36 (first quartile 32, third quartile 44) mm. Distal landing zone diameter increased at follow-up to max/min 33/31 mm and total aortic diameter of 48 (first quartile 42, third quartile 56) mm. There were 7 proximal and 10 distal stent graft induced new entries at follow-up. Substantial bird beak phenomenon was observed in 32%. Aortic reintervention was necessary in 22% with 9% proximal, 12% distal TEVAR extension, and 1% open aortic arch replacement.

Conclusion: Distal landing zone in patients undergoing TEVAR for descending aortic dissection is frequently dissected. High risk of distal stentgraft induced new entries and aortic diameter increase at distal landing zone underline the need for careful follow-up imaging controls.

No conflict of interest has been declared by the author(s).