OBJECTIVES Thoracic endovascular aortic repair (TEVAR) is the first-line therapy in acute complicated type B aortic dissections (cTBAD). Nevertheless, no evidence-based consensus on the optimal measurement technique and sizing for TEVAR in cTBAD exists. The aim was to evaluate how different measurement and sizing techniques for TEVAR affect long-term outcomes. METHODS Retrospective analysis investigating the association between sizing and postoperative results after TEVAR in patients with cTBAD, treated between January 2003 and December 2020. Diameter measurements were performed perpendicular to a centreline in pre-interventional Computed tomography angiographies. Oversizing was determined by measuring aortic diameter in zone 2 of the aortic arch in relation to the implanted stent graft, and categorized into 2 sizing groups (≤10% and >10%). The primary outcome was freedom from aortic-related events. Secondary outcomes included mortality and a comparison of 3 alternative measurement techniques considering the estimated pre-dissection diameter. RESULTS Fifty-seven patients (median age 69, interquartile range 59.6–78.2 years) were included. Stent graft oversizing by ≤10% showed a trend towards fewer aortic-related events hazard ratio 0.455 (95% confidence interval 0.128–1.624, P = 0.225). The 3 measurement techniques using the pre-dissection aortic diameter differed by a mean of 1.7–4.0 mm with a variability of up to 8.4 mm. In none of the 57 patients, the same stent graft would have been chosen based on the different measurement techniques using an oversizing ≤10%. CONCLUSIONS TEVAR oversizing of ≤10% in patients with cTBAD might reduce aortic-related events up to 50%. Consensus on measurement techniques of the pre-dissection aortic diameter and stent graft sizing is of paramount importance.

中文翻译：

---

胸主动脉腔内修复术中测量和尺寸技术对急性复杂B型主动脉夹层预后的影响

目的 胸主动脉腔内修复术 (TEVAR) 是急性复杂 B 型主动脉夹层 (cTBAD) 的一线治疗方法。然而，对于 cTBAD 中 TEVAR 的最佳测量技术和大小，尚无循证共识。目的是评估 TEVAR 的不同测量和规模技术如何影响长期结果。方法 回顾性分析调查 2003 年 1 月至 2020 年 12 月期间接受治疗的 cTBAD 患者 TEVAR 后尺寸与术后结果之间的关联。在介入前计算机断层扫描血管造影中垂直于中心线进行直径测量。通过测量主动脉弓区域 2 中与植入支架移植物相关的主动脉直径来确定过大尺寸，并将其分为 2 个尺寸组（≤10% 和 > 10%）。主要结果是无主动脉相关事件。次要结果包括死亡率和考虑估计的解剖前直径的 3 种替代测量技术的比较。结果 共纳入 57 名患者（中位年龄 69 岁，四分位距 59.6-78.2 岁）。支架移植物尺寸过大 ≤10% 显示出主动脉相关事件风险比 0.455 减少的趋势（95% 置信区间 0.128-1.624，P = 0.225）。使用解剖前主动脉直径的 3 种测量技术平均相差 1.7-4.0 毫米，可变性高达 8.4 毫米。在 57 名患者中，没有人会根据不同的测量技术选择相同的覆膜支架，使用尺寸过大 ≤10%。结论 cTBAD 患者 TEVAR 尺寸过大≤10% 可将主动脉相关事件减少多达 50%。