Risk factors for TEVAR-related post-implantation syndrome in Stanford type B aortic dissection patients

To investigate the risk factors associated with post-implantation syndrome（PIS）in Stanford type B aortic dissection（TBAD）patients undergoing thoracic endovascular aortic repair（TEVAR）and the relationship of PIS with short-term outcomes.

A case-control trial was conducted on the clinical data of patients undergoing TEVAR treatment for TBAD in our department from December 2013 to December 2022. They were divided into 2 groups based on the occurrence of PIS. Independent risk factors were analyzed according to the different clinical characteristics between the 2 groups. The overall 30-day mortality following TEVAR was assessed in both groups. Kaplan-Meier survival curves were utilized to evaluate the 30-day postoperative survival. Logistic regression models were constructed to investigate the relationship between PIS and overall mortality occurring within 30 d after TEVAR.

A total of 373 TBAD patients, with an average age of 57.9±12.1 years and a male ratio of 77.5%（289 cases）, were enrolled in this study. There were 106 cases（28.4%）experiencing PIS following TEVAR. Significantly larger proportions of implanted stents ≥2, operation duration ≥2 h and implantation of polyethylene terephthalate（PET）-coverted stents were observed in the PIS group than the non-PIS group（P<0.05）. Multivariate logistic regression analysis suggested that implanted stents ≥2（OR=1.886, 95%CI: 1.049~3.389, P=0.034）, operation duration ≥2 h（OR=1.938, 95%CI: 1.147~3.275, P=0.013）and implantation of PET-coverted stents（OR=2.131, 95%CI: 1.263~3.597, P=0.005）were independent risk factors for PIS after TEVAR. Within 30 d after TEVAR, 15（4.0%）cases dead, including 10（9.4%）from the PIS group and 5（1.9%）from the non-PIS group. Kaplan-Meier survival curve indicated a significantly lower survival in the PIS group（Log-rank P=0.000 7）. The results of multivariate logistic regression model indicated that cystatin C（OR=1.486, 95%CI: 1.053~2.097, P=0.024）and PIS（OR=5.628, 95%CI: 1.836~17.248, P=0.002）were independent risk factors for 30-day mortality after TEVAR in TBAD patients.

Implanted stents ≥2, operation duration ≥2 h and implantation of PET-coverted stents are closely associated with the occurrence PIS in TBAD patients after TEVAR. Cystatin C level and PIS are primary risk factors for poor 30-day prognosis after TEVAR.