Identification of perioperative risk factors for retrograde type A dissection after thoracic endovascular aortic repair for type B dissection

Objective To identify risk factors and develop a predictive model for retrograde type A dissection (RTAD) following thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD).Methods We analyzed TBAD patients who underwent TEVAR from 2014 to 2024 (IRB:No. TJ-IRB20230805). Patients developing RTAD within 1 year were matched with controls by age, sex, operation date, and location. Logistic regression identified risk factors, and a nomogram was constructed. Model performance was assessed using ROC curves.Results Of 2383 patients, 76 (3.19%) developed RTAD within one year. 65 RTAD cases and 195 matched controls were analyzed. RTAD patients had a greater horizontal distance of the ascending aorta (HDAA) than controls (53.34 mm vs. 43.05 mm, p < .001). Multivariate analysis identified younger age (OR = 0.95, p = .008), larger HDAA (OR = 1.14, p < .001), aortic root dilatation (OR = 2.85, p = .006), shorter stent length (OR = 0.99, p = .029), and absence of postoperative bradycardic drug use (OR = 0.31, p = .005) as independent RTAD risk factors. The model showed good discrimination (AUC = 0.85).Conclusion Younger age, larger HDAA, aortic root dilatation, shorter stent length, and no bradycardic drugs postoperatively are independent predictors of RTAD after TEVAR. For TBAD patients with a high risk of RTAD, clinicians should consider the possibility of having connective tissue diseases, select stents appropriately, and optimize postoperative treatment with strict follow-up.