CLINICAL STUDY Outcomes of Endovascular Management for Complicated Chronic Type B Aortic Dissection: Effect of the Extent of Stent Graft Coverage and Anatomic Properties of Aortic Dissection Myungsu Lee, MD, Do Yun Lee, MD, Man Deuk Kim, MD, Mu Sook Lee, MD, Jong Yun Won, MD, Sung Il Park, MD, Young Nam Yoon, MD, Sak Lee, MD, Donghoon Choi, MD, and Young-Guk Ko, MD ABSTRACT Purpose: To assess the effect of the extent of stent graft coverage and anatomic properties of aortic dissection on the outcomes of thoracic endovascular aortic repair (TEVAR) for complicated chronic type B aortic dissection (CCBAD) in terms of survival, reintervention, and false lumen thrombosis. Materials and Methods: A retrospective analysis was performed of 71 patients who underwent TEVAR for CCBAD. Mean patient age was 54.7 years. Distal extent of stent graft coverage was categorized as short (≤ T7) or long (≥ T8) coverage. Indications of reintervention were categorized into three groups: proximal, alongside, and distal according to the anatomic relationship of the culprit lesion and the stent graft. Overall survival, reintervention-free survival, and extent of false lumen thrombosis were compared. Results: The technical success rate was 97.2%. The 1-year, 3-year, and 5-year overall survival rates were 97.1%, 88.9%, and 88.9%, and 1-year, 3-year, and 5-year reintervention-free survival rates were 80.7%, 73.8%, and 60.6%. There were no differences in overall survival, reintervention-free survival rates, and extent of false lumen thrombosis between the groups. In the short coverage group, distal reintervention was more frequent in patients with an abdominal aortic diameter ≥ 37 mm compared with patients with an abdominal aortic diameter o 37 mm (P ¼ .005). Conclusions: TEVAR was effective for CCBAD with a high technical success rate and low mortality. The extent of stent graft coverage did not make a difference in terms of survival and false lumen thrombosis. Reinterventions were more frequently performed in patients with a large baseline abdominal aortic diameter who were treated with short stent graft coverage, and so longer coverage is recommended in such patients. ABBREVIATIONS CCBAD = complicated chronic type B aortic dissection, IQR = interquartile range, ROC = receiver operating characteristics, TEVAR = thoracic endovascular aortic repair Most survivors of acute aortic dissection have a patent false lumen with a persistent weakened and diseased aortic wall. Reports indicate that in-hospital mortality after surgical repair of proximal aortic dissection and complicated distal aortic dissection is 13%–33% and 2%– 39%, respectively (1). In-hospital mortality in cases of medically treated distal aortic dissection is reported to be 10% (2). Survivors of acute aortic dissection remain vulnerable to complications, such as aneurysmal degene- ration, persistent pain, recurrent dissection, visceral or limb malperfusion, and rupture, which may need subsequent interventions (3–6). Although thoracic endo- vascular aortic repair (TEVAR) is a proven therapeutic option for acute type B aortic dissection with better & SIR, 2013 J Vasc Interv Radiol 2013; 24:1451–1460 http://dx.doi.org/10.1016/j.jvir.2013.06.007 From the Department of Radiology and Research Institute of Radiological Science (M.L., D.Y.L., M.D.K., J.Y.W., S.I.P.), Department of Cardiothoracic Surgery, Cardiovascular Center (Y.N.Y., S.L.), and Division of Cardiology, Department of Internal Medicine, Cardiovascular Center (D.C., Y.-G.K.), Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Shinchon-dong, Seodaemun-gu, Seoul 120-752, Republic of Korea; and Department of Radiology (M.S.L.), Jeju National University Hospital, Seoul, Republic of Korea. Received December 9, 2012; final revision received June 4, 2013; accepted June 5, 2013. Address correspondence to M.D.K.; E-mail: mdkim@yuhs.ac