Concomitant antegrade stent grafting of the descending thoracic aorta during transverse hemiarch reconstruction for acute DeBakey I aortic dissection repair improves aortic remodeling

Background and aim: Concomitant endovascular stent grafting of the descending thoracic aorta during open repair for acute DeBakey I aortic dissection can be performed in patients with extensive dissection and malperfusion. We analyzed the effects of this strategy on distal aortic remodeling.

Methods: From 2006-2014, acute DeBakey I dissection patients without primary aortic arch tear undergoing open distal hemiarch reconstruction (Standard group) versus those undergoing hemiarch with descending thoracic aorta (DTA) thoracic endovascular aortic repair (TEVAR group) were retrospectively reviewed. We studied aortic remodeling only in patients with three-dimensional computed tomography scans available at 1 and 12 months following surgery (Standard group n = 26; Stent group n = 21).

Results: At 1 month, abdominal aortic diameters were similar, but true lumen (TL) and true lumen to total diameter ratios (TL index [TLI]) in the DTA were significantly improved in the TEVAR group (P < 0.05). Mean number of fenestrations were similar (1.8 ± 1.5 vs. 2.4 ± 1.9, P = 0.32). At 12 months, DTA true lumen and TLI remained significantly improved in the TEVAR group at all locations (P < 0.01). This translated to increased complete false lumen thrombosis rates in the thoracic aorta (83% vs. 32%, P = 0.01) in the TEVAR group. In the Standard group, DTA true lumen diameter and TL index were significantly decreased at 12 months compared to 1 month time period (P < 0.05). In the TEVAR group, DTA true lumen diameters and TLI were significantly improved at 12 months (P < 0.05).

Conclusions: Antegrade TEVAR during open repair for DeBakey I dissection improves DTA remodeling by increasing true lumen diameter without enlargement of the total aortic diameter and by promoting false lumen thrombosis.