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Objective <p>The indication for preemptive thoracic endovascular aortic repair (TEVAR) is expanding due to improved outcomes in uncomplicated type B aortic dissection (TBAD) compared with best medical therapy (BMT). Long-term outcomes and future treatment strategies for TBAD managed with preemptive TEVAR will be reported.</p> Subjects and methods <p>Of 432 patients with acute TBAD treated at two centers between July 2004 and August 2024, 324 patients who completed acute BMT (1–237&#xa0;months) were included. Their outcomes were compared with those of patients who did not undergo TEVAR.</p> Results <p>Of 324 patients, 277 (control group: CTR) continued BMT and 47 (Zone 2 landing n = 29, Zone 3 landing n = 7, others n = 11) underwent preemptive TEVAR. Propensity score matching was performed to compare the Zone 2 TEVAR group (Z2) with the CTR. There were more patients with patent false lumen in the Z2 (41% vs. 83%, <i>p</i> &lt; <i>0.05</i>). Pre- and post-TEVAR aortic diameters had decreased from 43.8 ± 6.8&#xa0;mm to 40.2 ± 10.0&#xa0;mm (<i>p</i> &lt; <i>0.001</i>) at 12&#xa0;months, the same value as the CTR (40.2 ± 11.7&#xa0;mm). The aortic event free rate (CTR vs. Z2, 1/5/10&#xa0;years) was 76/69/69% vs. 100/96/96%, respectively, (<i>p</i> &lt; <i>0.05</i>). Although two patients (7.1%) had aortic events (enlargement of aneurysms) after TEVAR, no aorta-related deaths.</p> Conclusion <p>Among patients who met the anatomic criteria, long-term outcomes of Zone 2 TEVAR performed during the subacute and early chronic phases were favorable. Preemptive TEVAR may be considered a viable treatment strategy for managing the aortic arch in the early stages of TBAD.</p>

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Impact of Zone 2 preemptive TEVAR on treatment strategy in uncomplicated type B aortic dissection: a 10-year outcome, study of 29 cases with Zone 2 placement

  • 期刊论文

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  • 发表日期：

    2026年3月27日

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  • Ken Nakamura,
  • Kentaro Akabane,
  • Kimihiro Kobayashi,
  • Shusuke Arai,
  • Miku Konaka,
  • Jun Hayashi,
  • Cholsu Kim,
  • Hideaki Uchino,
  • Takao Shimanuki,
  • Tetsuro Uchida

摘要

Objective

The indication for preemptive thoracic endovascular aortic repair (TEVAR) is expanding due to improved outcomes in uncomplicated type B aortic dissection (TBAD) compared with best medical therapy (BMT). Long-term outcomes and future treatment strategies for TBAD managed with preemptive TEVAR will be reported.

Subjects and methods

Of 432 patients with acute TBAD treated at two centers between July 2004 and August 2024, 324 patients who completed acute BMT (1–237 months) were included. Their outcomes were compared with those of patients who did not undergo TEVAR.

Results

Of 324 patients, 277 (control group: CTR) continued BMT and 47 (Zone 2 landing n = 29, Zone 3 landing n = 7, others n = 11) underwent preemptive TEVAR. Propensity score matching was performed to compare the Zone 2 TEVAR group (Z2) with the CTR. There were more patients with patent false lumen in the Z2 (41% vs. 83%, p < 0.05). Pre- and post-TEVAR aortic diameters had decreased from 43.8 ± 6.8 mm to 40.2 ± 10.0 mm (p < 0.001) at 12 months, the same value as the CTR (40.2 ± 11.7 mm). The aortic event free rate (CTR vs. Z2, 1/5/10 years) was 76/69/69% vs. 100/96/96%, respectively, (p < 0.05). Although two patients (7.1%) had aortic events (enlargement of aneurysms) after TEVAR, no aorta-related deaths.

Conclusion

Among patients who met the anatomic criteria, long-term outcomes of Zone 2 TEVAR performed during the subacute and early chronic phases were favorable. Preemptive TEVAR may be considered a viable treatment strategy for managing the aortic arch in the early stages of TBAD.