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Stanley G. A. 1, Murphy E. H. 2, Arko III F. R. 3
1 Division of Vascular and Endovascular Surgery, University of Texas Southwestern, Dallas, TX, USA;
2 Division of Vascular Surgery and Endovascular Therapy, University of Pennsylvania, Philadelphia, PA, USA;
3 Aortic Institute, Sanger Heart & Vascular Institute, Charlotte, NC, USA
Dissection of the thoracoabdominal aorta continues to be a challenging clinical pathology with often devastating outcomes. Uncomplicated type B aortic dissection is currently treated with strict blood pressure control and anti-impulse therapy with low rates of in-hospital mortality. Patients with complicated type B aortic dissection (TBAD), including rupture and malperfusion syndromes, traditionally have poor outcomes and progress to early death without surgical intervention. Thoracic endovascular aortic repair (TEVAR) has demonstrated significantly reduced morbidity and mortality over open repair for patients requiring surgery in both the acute and chronic setting. The goal of successful deployment of the thoracic stent-graft is to expand the true lumen size and induce thrombosis of the false lumen, a process referred to as aortic remodeling, which has been associated with superior long-term outcomes. However, the response to TEVAR is not consistent or predictable, and the mechanisms underlying continued patency of the false lumen are not completely understood. This document reviews the current literature examining aortic remodeling after TEVAR for both acute and chronic type B aortic dissection with a focus on the factors that influence clinical outcomes.