Outcomes of post-implantation syndrome after endovascular repair for Stanford type B aortic dissection

Abstract

Objective

To investigate the correlation between post-implantation syndrome (PIS) and long-term prognosis in patients with Stanford type B aortic dissection (TBAD) undergoing thoracic endovascular aortic repair (TEVAR).

Methods

This retrospective study included 547 consecutive patients diagnosed with TBAD who underwent TEVAR at our institution between January 2014 and December 2019. Patients were categorized into two groups: the PIS group (patients with post-TEVAR PIS) and the non-PIS group (patients without post-TEVAR PIS). In-hospital and follow-up data were analyzed.

Results

The incidence of PIS was 28.9% (158/547 patients). No baseline differences were observed between the PIS (n=158) and the non-PIS (n=389) groups. The proportion of emergency surgery in the PIS group was higher than that in the non-PIS group (44.9% vs. 26.0%, p<0.001), the operation time was longer [65.0 (56.0, 75.0) vs. 56.0 (45.0, 66.0) min, p<0.001], the volume of contrast medium used [65.0 (56.0, 75.0) vs. 56.0 (45.0, 66.0) mL, p<0.001], and the average number of trunk stents (1.85±0.4 vs. 1.34±0.5 piece, p<0.001) and branch stents (0.7±0.7 vs. 0.2±0.5 piece, p<0.001) used were more in the PIS group than in the non-PIS group. The incidence of supra-aortic branch procedures was higher in the PIS group than in the non-PIS group. There was no significant difference in device-related complications (DRC) or 30-day mortality between the two groups (2.5% vs. 4.4%, p=0.442 and 1.3% vs. 1.3%, p=0.688, respectively). Univariate and multivariable logistic regression analysis showed that emergency surgery, number of trunk stents >1, operation time >58.5 min, and contrast medium volume >75 mL were risk factors for PIS, and the odds ratios of emergency operation, number of trunk stents >1 piece, operation time >58.5 min, and contrast medium volume >75 mL were 2.526 (1.530–4.173), 4.651 (2.838–7.624), 3.577 (2.201–5.815), and 7.356 (4.111–13.160), respectively. Follow-up was completed in 98.5% (532/540) of the patients, with a median follow-up of 67 months (50, 86). There was no significant difference in survival between the PIS and non-PIS groups (12.4% vs. 10.3%, p=0.476) during follow-up. The incidences of DRC (7.8% vs. 11.6%, p=0.200) and aortic false lumen thrombosis (FLT) (75.8% vs. 79.2%, p=0.399) were comparable between the PIS and non-PIS groups. Univariate logistic regression analysis showed that PIS had no effect on long-term follow-up mortality, DRC, entry flow, or aortic FLT rate.

Conclusions

PIS is relatively common after TEVAR and emergency surgery; number of trunk stents >1, operation time >58.5 min, and contrast medium volume >75 mL are of high predictive value for the assessment of PIS after TEVAR. However, PIS had little effect on early and late postoperative mortality or DRC.