Risk factors, evaluation, and treatment advances for adverse distal aortic remodeling after type A aortic dissection repair: a systematic review

Abstract Objective Adverse distal aortic remodeling after type A aortic dissection (TAAD) repair is the principal cause of late aneurysm formation, rupture, and reintervention, significantly compromising long-term survival in patients with TAAD. Methods This study is a systematic review. A comprehensive search of Chinese and English databases up to December 10, 2025 was performed to systematically identify imaging-based risk factors for adverse distal aortic remodeling after TAAD repair and to summarize the efficacy and limitations of current endovascular intervention strategies. Results After systematically searching CNKI, Wanfang Data, VIP, PubMed, Embase, the Cochrane Library, and Web of Science, a total of 31 studies involving 5330 patients were included. Conclusion Imaging-based risk factors for adverse distal aortic remodeling include early postoperative descending aortic diameter ≥ 40 mm, a patent or partially thrombosed false lumen, and distal anastomotic new entry (DANE). Endovascular techniques, including false lumen occlusion, aortic true lumen stenting, and adjunctive intimal fenestration, can effectively improve patient outcomes. Early identification of high-risk patients and individualized intervention are key to enhancing the long-term prognosis of individuals with TAAD.