Early-term and midterm outcomes of endovascular completion of high-risk subacute and early chronic residual dissection after type A repair

Abstract

Objectives Late mortality, progressive aneurysmal degeneration, and major reinterventions remain frequent after repair of type A aortic dissection. This study aimed to evaluate early- and midterm outcomes of endovascular completion in patients with high-risk residual dissection treated during the subacute or early chronic phase. Methods This study was a single-center retrospective analysis of a prospectively maintained institutional database. All consecutive patients undergoing endovascular completion for high-risk residual aortic dissection after type A dissection repair between January 2017 and September 2025 were included. Completion was performed using thoracic endovascular aortic repair alone or combined with the stented-assisted balloon-induced intimal disruption and relamination technique when distal extension exceeded Ishimaru zone 5. Primary outcomes were 30-day mortality and morbidity, as well as 3- and 5-year survival and reintervention rates. Results Among 127 patients surviving initial type A repair, 48 (37.8%) underwent endovascular completion (subacute n = 33; early chronic n = 15). No 30-day deaths occurred, and technical success was achieved in all cases. Major adverse events occurred in 6.2%, with no spinal cord ischemia. Five patients (10.4%) required early reintervention. Median clinical follow-up was 54 months. Estimated survival was 97.9% at 3 years and 90.3% at 5 years. Freedom from major reintervention was 93.5% at 3 years and 89.1% at 5 years. False lumen thrombosis was achieved in 89.6% of thoracic and 81.4% of visceral segments. Conclusions Endovascular completion of high-risk residual dissection after type A repair is safe and effective, providing excellent midterm survival, low major reintervention rates, and high rates of aortic remodeling.