• Tae-Hoon Kim, Suk-Won Song, Kwang-Hun Lee, Min-Young Baek, Kyung-Jong Yoo, and Hye Sun Lee.
• Department of Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
• J. Thorac. Cardiovasc. Surg. 2018 Jul 1; 156 (1): 27-35.e1.

ObjectivesWe sought to identify the risk factors for abdominal aortic remodeling after thoracic endovascular aortic repair in patients with chronic DeBakey IIIb aneurysm.MethodsFrom 2012 to 2016, 70 patients underwent thoracic endovascular aortic repair for chronic DeBakey IIIb aneurysm. The abdominal aortic diameter was measured at 3 different levels (celiac trunk, renal artery, and infrarenal aorta). Abdominal aorta status was classified as expansion or stable. Expansion status was assigned when the abdominal aortic diameter was increased over 5 mm at least 1 level. Otherwise, it was classified as stable status. Forty-six of 70 patients underwent more than 2 postoperative imaging studies. In those patients (n = 46), abdominal aortic volume was measured from celiac trunk to inferior mesenteric artery. A linear mixed-effect model was used to analyze the overall fate of abdominal aortic volume.ResultsNo in-hospital mortality occurred. The mean follow-up and imaging follow-up duration were 26 and 17 months, respectively. Sixty-one patients (87.1%) demonstrated thoracic false-lumen thrombosis. Although false-lumen thrombosis was achieved, 15 patients (24.6%) demonstrated the expansion status. In volumetric analysis, the total abdominal aortic volume was increasing over time (0.603 cm3/mo; P < .001) and the residual intima tears were identified as an independent anatomic risk factor for an enlarged abdominal aorta.ConclusionsAn enlarged abdominal aorta in chronic DeBakey IIIb aneurysm can be frequently recognized even after successful endovascular treatment. The residual intima tears were the only identified risk factor for change in a dissected abdominal aneurysm. We suggest careful abdominal aorta evaluation and additional procedures on the false lumen if necessary.Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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