Risk factors of incomplete thrombosis in the false lumen after endovascular treatment of extensive acute type B aortic dissection

Objective: This study evaluated the risk factors of incomplete thrombosis in the false lumen after thoracic endovascular aortic repair (TEVAR) in patients with extensive acute type B aortic dissection. Methods: This was a retrospective study at Zhongda Hospital and Henan Provincial People's Hospital, China. Between January 2005 and May 2008, patients with acute type B dissection who underwent TEVAR at two centers were reviewed and 124 who met the following criteria were included in this study: (1) dissection involving the aorta below the level of the celiac artery, (2) completely patent false lumen at the time of intervention, and (3) complete initial diagnostic computed tomography (CT) scans and all follow-up CT scans available. Exclusion criteria were (1) aortic dissection secondary to trauma, (2) intramural hematoma, and (3) Marfan patients. The main outcome measures were demographics, comorbidity profiles, technical details of procedures, anatomic characteristics of dissection, and false lumen status of thrombosis during follow-up. Ordinal regression analysis was performed with variables that reached P < .20 on univariate analysis to investigate independent risk factors of incomplete thrombosis in the false lumen. Results: Univariate analysis showed that the age at TEVAR, hypertension, maximum diameter of the abdominal aorta and false lumen at the abdominal level, re-entry tears, and visceral branches that arose partially or totally from the false lumen had a P < .20. Further analysis with an ordinal regression model showed that the visceral branches that arose partially or totally from the false lumen (odds ratio [OR], 10.054; P < .001), re-entry tears (OR, 30.661; P < .001), and maximum diameter of the false lumen on the abdominal aorta (OR, 1.265; P = .004) were the significant risk factors of incomplete thrombosis in the false lumen after TEVAR. Conclusions: Visceral branches that arose partially or totally from the false lumen, re-entry tears, and maximum diameter of the false lumen on the abdominal aorta were the risk factors of incomplete thrombosis in the false lumen after TEVAR in extensive acute type B dissection. (J Vasc Surg 2012;56:1232-8.)