This was a retrospective study. The study was conducted between March 2003 to October 2018. From 5 medical centers, 814 patients with acute cTBAD were selected. DASE is defined as the increase in distal aortic segmental volume ≥ 1.6-fold compared to the preoperated volume. The preoperative volume was compared to that of postoperative volume in computed tomography angiography scan (CTA) scan. Out of 814 patients selected, 635(78%) were identified as non-DASE, and 179(22%) were identified as DASE. To compare late death and distal aortic reintervention between the two groups, a complete risk analysis was done. Based on preoperative CTA and the newest CTA, the morphological variables and false lumen thrombosis at 7 aortic levels were noted. To evaluate the independent predictors of DASE, Univariate and multivariate Cox regression analysis were performed.
The patients in both groups were followed up to a mean of 5.6 years (interquartile range: 2.4-8.3 years). A total of 208 late deaths occurred, which included 94(14.8) deaths in non-DASE group versus 114(63.7%) deaths in DASE group. In 89 patients, distal aortic reintervention was observed. Out of this, 43(6.7%) were patients in the non-DASE group and 46(25.7%) in the DASE group. The total number of late deaths and distal aortic reintervention were significantly higher in the DASE patients that in non-DASE patients (P<0.001). A significant incomplete false lumen thrombosis was observed in all distal aortic segments above the aortic level of celiac artery(P<0.01). The independent factors of DASE were the Marfan syndrome, stent coverage to the level of the diaphragm and the level of the celiac artery according to multivariate analysis(P<0.001). Patients with extended stent coverage to the level of the celiac artery presented with a lower rate of DASE(P<0.010).
Patients with DASE showed a higher rate of late death and distal aortic reintervention that those of non-DASE group. In patients with cTBAD, extended stent-graft coverage to the aortic section between diaphragm and celiac artery might serve to be an economic intervention and help in reducing the risk of (DASE).