Work

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

Year: 2026

Type: article

Abstract: 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.

Source: General Thoracic and Cardiovascular Surgery

DOI: 10.1007/s11748-026-02276-w