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

Objective: The aim of this study was to investigate the correlation between post-implantation syndrome (PIS) and longterm 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 < . 001), the operation time was longer (median, 65.0; interquartile range [IQR], 56.0-75.0 minutes vs 56.0; IQR, 45.0-66.0 minutes; P < . 001), the volume of contrast medium used (median, 65.0; IQR, 56.0-75.0 mL vs 56.0; IQR, 45.0-66.0 mL; P < . 001), and the average number of trunk stents (1.85 +/- 0.4 vs 1.34 +/- 0.5 pieces; P < . 001) and branch stents (0.7 +/- 0.7 vs 0.2 +/- 0.5 pieces; P < . 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 fi cant difference in device-related complications (DRCs) or 30-day mortality between the two groups (2.5% vs 4.4%; P = . 442 and 1.3% vs 1.3%; P = . 688, respectively). Univariate and multivariable logistic regression analysis showed that emergency surgery, number of trunk stents > 1, operation time > 58.5 minutes, 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 minutes, and contrast medium volume > 75 mL were 2.526 (95% confidence fi dence interval [CI], 1.530-4.173), 4.651 (95% CI, 2.838-7.624), 3.577 (95% CI, 2.201-5.815), and 7.356 (95% CI, 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 (IQR, 50-86 months). There was no significant fi cant difference in survival between the PIS and non-PIS groups (12.4% vs 10.3%; P = . 476) during follow-up. The incidences of DRCs (7.8% vs 11.6%; P = . 200) and aortic false lumen thrombosis (75.8% vs 79.2%; P = . 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, DRCs, entry fl ow, or aortic false lumen thrombosis rate. Conclusions: PIS is relatively common after TEVAR and emergency surgery; number of trunk stents > 1, operation time > 58.5 minutes, 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 DRCs. (J Vasc Surg 2024;79:1326-38.)