Research progress on distal aortic remodeling in chronic post-dissection aortic aneurysms_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIA Jiangwen , LIU Yu , YANG Peng , LU Chen , WANG Chenhao , PU Zhongyao ,  HU Jia

Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding?author：

HU Jia, Email: Jiahu@wchscu.edu.cn

Keywords：

Chronic post-dissection aortic aneurysm; aortic remodeling; residual false lumen; thoracic endovascular aortic repair; hybrid surgery; computational fluid dynamics; fenestrated and branched endovascular repair; genetic aortic disease

DOI：

10.7507/1007-4848.202602017

Video：

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Abstract Full text Figures/Tables Video References Cited by

Chronic post-dissection aortic aneurysms (PDAAs) are severe long-term complications following surgical or medical conservative management of aortic dissection, primarily caused by persistent perfusion of the residual false lumen. The persistent patency of the residual false lumen is the key pathological mechanism leading to adverse distal aortic remodeling, which can result in progressive aortic dilation, increased risk of rupture, and elevated reintervention requirements, significantly affecting patients' long-term prognosis. This article reviews the latest research progress on assessment methods, influencing factors, and intervention strategies for distal aortic remodeling in PDAAs, aiming to provide reference for clinical decision-making.

1.	肖雨桐, 舒暢. 慢性胸腹主動脈夾層動脈瘤治療選擇. 中國普外基礎與臨床雜志, 2024, 31(6): 656-663.Xiao YT, Shu C. Treatment options for chronic thoracoabdominal aortic dissection aneurysms. Chin J Bases Clin General Surg, 2024, 31(6): 656-663.
2.	Tenorio ER, Oderich GS, Farber MA, et al. Outcomes of endovascular repair of chronic postdissection compared with degenerative thoracoabdominal aortic aneurysms using fenestrated-branched stent grafts. J Vasc Surg, 2020, 72(3): 822-836.
3.	Isselbacher EM, Preventza O, Hamilton Black J, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology joint committee on clinical practice guidelines. Circulation, 2022, 146(24): e334-e482.
4.	Fleischmann D, Afifi RO, Casanegra AI, et al. Imaging and surveillance of chronic aortic dissection: a scientific statement from the American Heart Association. Circ Cardiovasc Imaging, 2022, 15(3): e000075.
5.	陳曉燁, 盧晨, 胡佳. Stanford A型主動脈夾層近端修復術后遠端主動脈重塑的研究進展. 中國胸心血管外科臨床雜志, 2021, 28(9): 1102-1106.Chen XY, Lu C, Hu J. Research progress on distal aortic remodeling after proximal repair of Stanford type A aortic dissection. Chin J Clin Thorac Cardiovasc Surg, 2021, 28(9): 1102-1106.
6.	Dohle DS, Tsagakis K, Janosi RA, et al. Aortic remodelling in aortic dissection after frozen elephant trunk. Eur J Cardiothorac Surg, 2016, 49(1): 111-117.
7.	張嵐林, 陽晟, 高慧強, 等. Stanford B型主動脈夾層腔內修復術后遠端負性重塑相關因素淺析. 中華外科雜志, 2022, 60(11): 987-991.Zhang LL, Yang S, Gao HQ, et al. Factors related to distal negative remodeling after endovascular repair of Stanford type B aortic dissection. Chin J Surg, 2022, 60(11): 987-991.
8.	Lombardi JV, Hughes GC, Appoo JJ, et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. J Vasc Surg, 2020, 71(3): 723-747.
9.	Neves PJF, Brett Reece T, Jacobs DL, et al. Aortic remodeling following aortic dissection: the time for standardization is now. J Endovasc Ther, 2025, 32(2): 271-275.
10.	Porto A, Omnes V, Bartoli MA, et al. Reintervention of residual aortic dissection after type A aortic repair: results of a prospective follow-up at 5 years. J Clin Med, 2023, 12(6): 2363.
11.	Patterson BO, Vidal-Diez A, Karthikesalingam A, et al. Comparison of aortic diameter and area after endovascular treatment of aortic dissection. Ann Thorac Surg, 2015, 99(1): 95-102.
12.	Ismaguilova A, Martufi G, Gregory AJ, et al. Multidimensional analysis of descending aortic growth after acute type A aortic dissection. Ann Thorac Surg, 2021, 111(2): 615-621.
13.	Usai MV, Ibrahim A, Oberhuber A, et al. Quantification of volume changes in the descending aorta after frozen elephant trunk procedure using the Thoraflex hybrid prosthesis for type A aortic dissection. J Thorac Dis, 2021, 13(1): 60-66.
14.	Xu H, Xiong J, Han X, et al. Computed tomography-based hemodynamic index for aortic dissection. J Thorac Cardiovasc Surg, 2021, 162(2): e165-e176.
15.	Leontyev S, Haag F, Davierwala PM, et al. Postoperative changes in the distal residual aorta after surgery for acute type A aortic dissection: impact of false lumen patency and size of descending aorta. Thorac Cardiovasc Surg, 2017, 65(2): 90-98.
16.	Kim JH, Lee SH, Lee S, et al. Role of false lumen area ratio in late aortic events after acute type Ⅰ aortic dissection repair. Ann Thorac Surg, 2022, 114(6): 2217-2224.
17.	Gaudry M, Guivier-Curien C, Blanchard A, et al. Volume analysis to predict the long-term evolution of residual aortic dissection after type A repair. J Cardiovasc Dev Dis, 2022, 9(10): 349.
18.	Ikeno Y, Yokawa K, Koda Y, et al. The fate of the downstream aorta after open aortic repair for acute DeBakey type I aortic dissection: total arch replacement with elephant trunk technique versus non-total arch replacement. Eur J Cardiothorac Surg, 2019, 55(5): 966-974.
19.	Fattouch K, Sampognaro R, Navarra E, et al. Long-term results after repair of type a acute aortic dissection according to false lumen patency. Ann Thorac Surg, 2009, 88(4): 1244-1250.
20.	Kayali F, Jubouri M, Tan SZ, et al. Aortic remodeling in aortic dissection after frozen elephant trunk: overcoming the challenges. J Cardiovasc Surg (Torino), 2022, 63(4): 434-438.
21.	Suzuki T, Asai T, Kinoshita T. Predictors for late reoperation after surgical repair of acute type A aortic dissection. Ann Thorac Surg, 2018, 106(1): 63-69.
22.	Heo W, Song SW, Lee KH, et al. Surgery for acute type Ⅰaortic dissection without resection of supra-aortic entry sites leads to unfavourable aortic remodelling. Eur J Cardiothorac Surg, 2018, 54(1): 34-41.
23.	Kim JH, Lee SH, Lee S, et al. The impact of a reentry tear after open repair of nonsyndromic acute type I aortic dissection. Ann Thorac Surg, 2020, 110(2): 475-482.
24.	Zhu Y, Xu XY, Rosendahl U, et al. Prediction of aortic dilatation in surgically repaired type A dissection: a longitudinal study using computational fluid dynamics. JTCVS Open, 2022, 9: 11-27.
25.	Takei Y, Miyazaki S, Suzuki K, et al. Hemodynamic predictors of negative false lumen remodeling after frozen elephant trunk for acute aortic dissection. Gen Thorac Cardiovasc Surg, 2024, 72(6): 376-386.
26.	Fatma K, Carine GC, Marine G, et al. Numerical modeling of residual type B aortic dissection: longitudinal analysis of favorable and unfavorable evolution. Med Biol Eng Comput, 2022, 60(3): 769-783.
27.	Melby SJ, Zierer A, Damiano RJ, et al. Importance of blood pressure control after repair of acute type a aortic dissection: 25-year follow-up in 252 patients. J Clin Hypertens (Greenwich), 2013, 15(1): 63-68.
28.	Chen Y, Ma WG, Zhi AH, et al. Fate of distal aorta after frozen elephant trunk and total arch replacement for type A aortic dissection in Marfan syndrome. J Thorac Cardiovasc Surg, 2019, 157(3): 835-849.
29.	Evangelista A, Salas A, Ribera A, et al. Long-term outcome of aortic dissection with patent false lumen: predictive role of entry tear size and location. Circulation, 2012, 125(25): 3133-3141.
30.	Weiss G, Arnold Z, Folkmann S, et al. From back table innovation to contemporary application: a review of the frozen elephant trunk technique. Ann Cardiothorac Surg, 2025, 14(5): 335-342.
31.	Weiss G, Santer D, Dumfarth J, et al. Evaluation of the downstream aorta after frozen elephant trunk repair for aortic dissections in terms of diameter and false lumen status. Eur J Cardiothorac Surg, 2016, 49(1): 118-124.
32.	Iafrancesco M, Goebel N, Mascaro J, et al. Aortic diameter remodelling after the frozen elephant trunk technique in aortic dissection: results from an international multicentre registry. Eur J Cardiothorac Surg, 2017, 52(2): 310-318.
33.	Jubouri M, Kayali F, Saha P, et al. Incidence of distal stent graft induced new entry vs. aortic remodeling associated with frozen elephant trunk. Front Cardiovasc Med, 2022, 9: 875078.
34.	Fichadiya A, Gregory AJ, Kotha VK, et al. Extended-arch repair for acute type-A aortic dissection: perioperative and mid-term results. Eur J Cardiothorac Surg, 2019, 56(4): 714-721.
35.	Rathore KS. Distal aortic remodeling after type A dissection repair: an ongoing mirage. J Chest Surg, 2021, 54(6): 439-448.
36.	Tamura K, Chikazawa G, Hiraoka A, et al. The prognostic impact of distal anastomotic new entry after acute type Ⅰaortic dissection repair. Eur J Cardiothorac Surg, 2017, 52(5): 867-873.
37.	Wang J, Gao H, Zhang X, et al. Study on the remodeling of distal residual dissection after surgery in patients with type A aortic dissection and Marfan syndrome. JTCVS Open, 2025, 26: 15-21.
38.	Rolf-Pissarczyk M, Schussnig R, Fries TP, et al. Mechanisms of aortic dissection: from pathological changes to experimental and in silico models. Prog Mater Sci, 2025, 150: 101363.
39.	Humphrey JD, Schwartz MA, Tellides G, et al. Role of mechanotransduction in vascular biology: focus on thoracic aortic aneurysms and dissections. Circ Res, 2015, 116(8): 1448-1461.
40.	Zhang X, Wu D, Choi JC, et al. Matrix metalloproteinase levels in chronic thoracic aortic dissection. J Surg Res, 2014, 189(2): 348-358.
41.	Sanches AF, Wan Z, Hasemaki N, et al. Computational fluid dynamics in aortic arch pathologies: current applications, challenges, and future perspectives. J Cardiovasc Surg (Torino), 2025, 66(6): 507-516.
42.	Kozlov BN, Panfilov DS, Saushkin VV, et al. Distal aortic remodelling after the standard and the elongated frozen elephant trunk procedure. Interact Cardiovasc Thorac Surg, 2019, 29(1): 117-123.
43.	Iida Y, Fujii S, Shimizu H, et al. Patterns of aortic remodelling after total arch replacement with frozen elephant trunk for acute aortic dissection. Interact Cardiovasc Thorac Surg, 2019, 29(6): 923-929.
44.	Kazimierczak A, Rynio P. Extended petticoat strategy in type B aortic dissection. Eur J Vasc Endovasc Surg, 2019, 57(2): 302.
45.	Chen B, Huang K, Zhuang X, et al. Staging reinterventions for remodeling of residual aortic dissection: a single-center retrospective study. Front Cardiovasc Med, 2024, 11: 1360830.
46.	K?lbel T, Carpenter SW, Lohrenz C, et al. Addressing persistent false lumen flow in chronic aortic dissection: the knickerbocker technique. J Endovasc Ther, 2014, 21(1): 117-122.
47.	Rohlffs F, Tsilimparis N, Panuccio G, et al. The Knickerbocker technique: technical aspects and single-center results of a new endovascular method for false lumen occlusion in chronic aortic dissection. J Endovasc Ther, 2023, 30(4): 609-614.
48.	Mylonas SN, Aras T, Dorweiler B. A systematic review and an updated meta-analysis of fenestrated/branched endovascular aortic repair of chronic post-dissection thoracoabdominal aortic aneurysms. J Clin Med, 2024, 13(2): 410.

1. 肖雨桐, 舒暢. 慢性胸腹主動脈夾層動脈瘤治療選擇. 中國普外基礎與臨床雜志, 2024, 31(6): 656-663.Xiao YT, Shu C. Treatment options for chronic thoracoabdominal aortic dissection aneurysms. Chin J Bases Clin General Surg, 2024, 31(6): 656-663.
2. Tenorio ER, Oderich GS, Farber MA, et al. Outcomes of endovascular repair of chronic postdissection compared with degenerative thoracoabdominal aortic aneurysms using fenestrated-branched stent grafts. J Vasc Surg, 2020, 72(3): 822-836.
3. Isselbacher EM, Preventza O, Hamilton Black J, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology joint committee on clinical practice guidelines. Circulation, 2022, 146(24): e334-e482.
4. Fleischmann D, Afifi RO, Casanegra AI, et al. Imaging and surveillance of chronic aortic dissection: a scientific statement from the American Heart Association. Circ Cardiovasc Imaging, 2022, 15(3): e000075.
5. 陳曉燁, 盧晨, 胡佳. Stanford A型主動脈夾層近端修復術后遠端主動脈重塑的研究進展. 中國胸心血管外科臨床雜志, 2021, 28(9): 1102-1106.Chen XY, Lu C, Hu J. Research progress on distal aortic remodeling after proximal repair of Stanford type A aortic dissection. Chin J Clin Thorac Cardiovasc Surg, 2021, 28(9): 1102-1106.
6. Dohle DS, Tsagakis K, Janosi RA, et al. Aortic remodelling in aortic dissection after frozen elephant trunk. Eur J Cardiothorac Surg, 2016, 49(1): 111-117.
7. 張嵐林, 陽晟, 高慧強, 等. Stanford B型主動脈夾層腔內修復術后遠端負性重塑相關因素淺析. 中華外科雜志, 2022, 60(11): 987-991.Zhang LL, Yang S, Gao HQ, et al. Factors related to distal negative remodeling after endovascular repair of Stanford type B aortic dissection. Chin J Surg, 2022, 60(11): 987-991.
8. Lombardi JV, Hughes GC, Appoo JJ, et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. J Vasc Surg, 2020, 71(3): 723-747.
9. Neves PJF, Brett Reece T, Jacobs DL, et al. Aortic remodeling following aortic dissection: the time for standardization is now. J Endovasc Ther, 2025, 32(2): 271-275.
10. Porto A, Omnes V, Bartoli MA, et al. Reintervention of residual aortic dissection after type A aortic repair: results of a prospective follow-up at 5 years. J Clin Med, 2023, 12(6): 2363.
11. Patterson BO, Vidal-Diez A, Karthikesalingam A, et al. Comparison of aortic diameter and area after endovascular treatment of aortic dissection. Ann Thorac Surg, 2015, 99(1): 95-102.
12. Ismaguilova A, Martufi G, Gregory AJ, et al. Multidimensional analysis of descending aortic growth after acute type A aortic dissection. Ann Thorac Surg, 2021, 111(2): 615-621.
13. Usai MV, Ibrahim A, Oberhuber A, et al. Quantification of volume changes in the descending aorta after frozen elephant trunk procedure using the Thoraflex hybrid prosthesis for type A aortic dissection. J Thorac Dis, 2021, 13(1): 60-66.
14. Xu H, Xiong J, Han X, et al. Computed tomography-based hemodynamic index for aortic dissection. J Thorac Cardiovasc Surg, 2021, 162(2): e165-e176.
15. Leontyev S, Haag F, Davierwala PM, et al. Postoperative changes in the distal residual aorta after surgery for acute type A aortic dissection: impact of false lumen patency and size of descending aorta. Thorac Cardiovasc Surg, 2017, 65(2): 90-98.
16. Kim JH, Lee SH, Lee S, et al. Role of false lumen area ratio in late aortic events after acute type Ⅰ aortic dissection repair. Ann Thorac Surg, 2022, 114(6): 2217-2224.
17. Gaudry M, Guivier-Curien C, Blanchard A, et al. Volume analysis to predict the long-term evolution of residual aortic dissection after type A repair. J Cardiovasc Dev Dis, 2022, 9(10): 349.
18. Ikeno Y, Yokawa K, Koda Y, et al. The fate of the downstream aorta after open aortic repair for acute DeBakey type I aortic dissection: total arch replacement with elephant trunk technique versus non-total arch replacement. Eur J Cardiothorac Surg, 2019, 55(5): 966-974.
19. Fattouch K, Sampognaro R, Navarra E, et al. Long-term results after repair of type a acute aortic dissection according to false lumen patency. Ann Thorac Surg, 2009, 88(4): 1244-1250.
20. Kayali F, Jubouri M, Tan SZ, et al. Aortic remodeling in aortic dissection after frozen elephant trunk: overcoming the challenges. J Cardiovasc Surg (Torino), 2022, 63(4): 434-438.
21. Suzuki T, Asai T, Kinoshita T. Predictors for late reoperation after surgical repair of acute type A aortic dissection. Ann Thorac Surg, 2018, 106(1): 63-69.
22. Heo W, Song SW, Lee KH, et al. Surgery for acute type Ⅰaortic dissection without resection of supra-aortic entry sites leads to unfavourable aortic remodelling. Eur J Cardiothorac Surg, 2018, 54(1): 34-41.
23. Kim JH, Lee SH, Lee S, et al. The impact of a reentry tear after open repair of nonsyndromic acute type I aortic dissection. Ann Thorac Surg, 2020, 110(2): 475-482.
24. Zhu Y, Xu XY, Rosendahl U, et al. Prediction of aortic dilatation in surgically repaired type A dissection: a longitudinal study using computational fluid dynamics. JTCVS Open, 2022, 9: 11-27.
25. Takei Y, Miyazaki S, Suzuki K, et al. Hemodynamic predictors of negative false lumen remodeling after frozen elephant trunk for acute aortic dissection. Gen Thorac Cardiovasc Surg, 2024, 72(6): 376-386.
26. Fatma K, Carine GC, Marine G, et al. Numerical modeling of residual type B aortic dissection: longitudinal analysis of favorable and unfavorable evolution. Med Biol Eng Comput, 2022, 60(3): 769-783.
27. Melby SJ, Zierer A, Damiano RJ, et al. Importance of blood pressure control after repair of acute type a aortic dissection: 25-year follow-up in 252 patients. J Clin Hypertens (Greenwich), 2013, 15(1): 63-68.
28. Chen Y, Ma WG, Zhi AH, et al. Fate of distal aorta after frozen elephant trunk and total arch replacement for type A aortic dissection in Marfan syndrome. J Thorac Cardiovasc Surg, 2019, 157(3): 835-849.
29. Evangelista A, Salas A, Ribera A, et al. Long-term outcome of aortic dissection with patent false lumen: predictive role of entry tear size and location. Circulation, 2012, 125(25): 3133-3141.
30. Weiss G, Arnold Z, Folkmann S, et al. From back table innovation to contemporary application: a review of the frozen elephant trunk technique. Ann Cardiothorac Surg, 2025, 14(5): 335-342.
31. Weiss G, Santer D, Dumfarth J, et al. Evaluation of the downstream aorta after frozen elephant trunk repair for aortic dissections in terms of diameter and false lumen status. Eur J Cardiothorac Surg, 2016, 49(1): 118-124.
32. Iafrancesco M, Goebel N, Mascaro J, et al. Aortic diameter remodelling after the frozen elephant trunk technique in aortic dissection: results from an international multicentre registry. Eur J Cardiothorac Surg, 2017, 52(2): 310-318.
33. Jubouri M, Kayali F, Saha P, et al. Incidence of distal stent graft induced new entry vs. aortic remodeling associated with frozen elephant trunk. Front Cardiovasc Med, 2022, 9: 875078.
34. Fichadiya A, Gregory AJ, Kotha VK, et al. Extended-arch repair for acute type-A aortic dissection: perioperative and mid-term results. Eur J Cardiothorac Surg, 2019, 56(4): 714-721.
35. Rathore KS. Distal aortic remodeling after type A dissection repair: an ongoing mirage. J Chest Surg, 2021, 54(6): 439-448.
36. Tamura K, Chikazawa G, Hiraoka A, et al. The prognostic impact of distal anastomotic new entry after acute type Ⅰaortic dissection repair. Eur J Cardiothorac Surg, 2017, 52(5): 867-873.
37. Wang J, Gao H, Zhang X, et al. Study on the remodeling of distal residual dissection after surgery in patients with type A aortic dissection and Marfan syndrome. JTCVS Open, 2025, 26: 15-21.
38. Rolf-Pissarczyk M, Schussnig R, Fries TP, et al. Mechanisms of aortic dissection: from pathological changes to experimental and in silico models. Prog Mater Sci, 2025, 150: 101363.
39. Humphrey JD, Schwartz MA, Tellides G, et al. Role of mechanotransduction in vascular biology: focus on thoracic aortic aneurysms and dissections. Circ Res, 2015, 116(8): 1448-1461.
40. Zhang X, Wu D, Choi JC, et al. Matrix metalloproteinase levels in chronic thoracic aortic dissection. J Surg Res, 2014, 189(2): 348-358.
41. Sanches AF, Wan Z, Hasemaki N, et al. Computational fluid dynamics in aortic arch pathologies: current applications, challenges, and future perspectives. J Cardiovasc Surg (Torino), 2025, 66(6): 507-516.
42. Kozlov BN, Panfilov DS, Saushkin VV, et al. Distal aortic remodelling after the standard and the elongated frozen elephant trunk procedure. Interact Cardiovasc Thorac Surg, 2019, 29(1): 117-123.
43. Iida Y, Fujii S, Shimizu H, et al. Patterns of aortic remodelling after total arch replacement with frozen elephant trunk for acute aortic dissection. Interact Cardiovasc Thorac Surg, 2019, 29(6): 923-929.
44. Kazimierczak A, Rynio P. Extended petticoat strategy in type B aortic dissection. Eur J Vasc Endovasc Surg, 2019, 57(2): 302.
45. Chen B, Huang K, Zhuang X, et al. Staging reinterventions for remodeling of residual aortic dissection: a single-center retrospective study. Front Cardiovasc Med, 2024, 11: 1360830.
46. K?lbel T, Carpenter SW, Lohrenz C, et al. Addressing persistent false lumen flow in chronic aortic dissection: the knickerbocker technique. J Endovasc Ther, 2014, 21(1): 117-122.
47. Rohlffs F, Tsilimparis N, Panuccio G, et al. The Knickerbocker technique: technical aspects and single-center results of a new endovascular method for false lumen occlusion in chronic aortic dissection. J Endovasc Ther, 2023, 30(4): 609-614.
48. Mylonas SN, Aras T, Dorweiler B. A systematic review and an updated meta-analysis of fenestrated/branched endovascular aortic repair of chronic post-dissection thoracoabdominal aortic aneurysms. J Clin Med, 2024, 13(2): 410.

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