Long-term outcomes of aortic arch preemptive thoracic endovascular aortic repair for uncomplicated type B aortic dissection.

PURPOSE: Preemptive thoracic endovascular aortic repair (TEVAR) has been used increasingly for uncomplicated type B aortic dissection (TBAD); however, its optimal indications remain controversial, particularly when the proximal landing zone involves the aortic arch. We evaluated the long-term outcomes of aortic arch preemptive TEVAR for uncomplicated TBAD. METHODS: Between July 2004 and January 2026, 473 patients with acute TBAD were treated at our institution and affiliated hospitals, 351 of whom completed initial medical therapy (follow-up, 1-241 months). Preemptive TEVAR was performed in 52 patients and 299 were managed medically. The subjects of this study were 41 patients who underwent preemptive TEVAR with a proximal landing zone in Zone 2 or 3. We compared the outcomes and aortic morphology on serial computed tomography (CT) of these 41 patients with those of 41 propensity-matched patients who did not undergo TEVAR. RESULTS: Before matching, the TEVAR group had a higher prevalence of patent false lumen and a larger false lumen diameter. Freedom from aortic adverse events was higher in the TEVAR group during long-term follow-up, although the difference was not significant (P = 0.065). There were no aortic-related deaths after TEVAR, and CT demonstrated favorable aortic remodeling. CONCLUSIONS: Aortic arch preemptive TEVAR was associated with favorable aortic remodeling and a trend toward improved long-term aortic outcomes.