THORACIC endovascular aortic repair (TEVAR) in patients with type B aortic dissection (TBAD) significantly reduces false lumen (FL) pulse pressure, while branch artery involvement strongly correlates with elevated FL systolic pressure.
Aortic dissection, particularly of the type B variant, remains a life-threatening condition requiring careful management of the pressure dynamics within the dissected aorta. The presence of elevated blood pressure in the false lumen (FL) is thought to play a critical role in ongoing aortic dilation and the risk of rupture; therefore, understanding these haemodynamic changes is essential for surgical practice. TEVAR, which seals the primary tear, has become the preferred approach, but direct intraoperative evidence of its effect on true lumen (TL) and FL pressures has been limited.
This single-centre study evaluated intraoperative changes in true and false lumen pressures during TEVAR in 23 patients with TBAD, treated between 2021 and 2024. Detailed pressure measurements were taken in both the TL and FL at various points during the procedure. The cohort underwent additional intraoperative assessments, including blood pressure waveform analysis and digital subtraction angiography. Preoperative to postoperative measurements showed a significant reduction in FL pulse pressure difference, falling from 40.3 ± 20.5 mmHg before TEVAR to 25.3 ± 14.9 mmHg afterwards (p<0.001), indicating successful reduction of haemodynamic stress in the FL. In contrast, TL pressure remained stable following the intervention. Subgroup analysis highlighted that even in chronic-phase patients, FL pulse pressure was significantly decreased post-TEVAR (45.0 ± 20.9 to 28.9 ± 17.5 mmHg; p=0.002). Notably, the study found that 73.9% of patients exhibited higher systolic pressure in the TL with an earlier systolic peak, and multivariable analysis identified that the presence of visceral arteries arising from the FL (OR=0.02, 95% CI=0.01–0.47) and proximity of the FL to the spine (OR=0.05, 95% CI=0.01–0.77) were both independently associated with higher FL systolic pressure. Over follow-up, one patient died and two underwent further interventions for aortic enlargement.
These findings reinforce the importance of addressing branch artery involvement in TBAD, given its strong association with persistent FL hypertension. TEVAR effectively reduces FL pressure and should remain the cornerstone for acute and chronic TBAD management. For clinical practice, intraoperative pressure monitoring may help to identify patients at greater risk of adverse outcomes and guide endovascular strategy, particularly regarding branch vessel origins. Future research should focus on optimising techniques for those with complex branch involvement to further reduce reintervention rates and improve long-term outcomes.
Reference
Zhang L et al. Changes in true and false lumen pressures during closure of the primary tear in aortic dissection. Catheter Cardiovasc Interv. 2025;DOI:10.1002/ccd.31722.
