Clinical outcomes of type B aortic dissection with ductus arteriosus diverticulum: a comparative study after endovascular repair

This study compared clinical presentation, perioperative and long-term outcomes of thoracic endovascular aortic repair for type B aortic dissection between patients with and without ductus arteriosus diverticulum. A retrospective cohort study was conducted involving patients diagnosed with type B aortic dissection who underwent thoracic endovascular aortic repair between 2018 and 2022. Patients were stratified according to the presence or absence of ductus arteriosus diverticulum. Baseline characteristics were systematically compared, and propensity score matching was performed for outcome assessment. Among the 779 patients included in the study, 78 (10%) were classified into the ductus arteriosus diverticulum group. Ductus arteriosus diverticulum patients were significantly younger (48.3 vs. 54.8 years, P < 0.001) and had fewer proximal landing zones in Ishimaru zone 0–2 (16.7% vs. 38.4%, P < 0.001). After matching, ductus arteriosus diverticulum patients more often had convex-side primary entry tears (89.74% vs. 75.64%, P = 0.02), with similar postoperative and 30-day outcomes. At median follow-up of approximately 4.2 years, no differences were seen in 1-year mortality ( P = 0.560) or estimated 6-year survival ( P = 0.435), though ductus arteriosus diverticulum patients had better freedom from adverse events (88.14% vs. 80.32%, P = 0.048). Multivariable logistic regression analysis showed that stroke and emergency surgery were predictors of mortality, while stroke and a concave-side primary entry tear of the aortic arch were associated with adverse events. Ductus arteriosus diverticulum patients were significantly younger and more likely to exhibit primary entry tears on the convex side of the aortic arch, potentially contributing to improved post-thoracic endovascular aortic repair outcomes.