Adjunctive false lumen intervention for chronic aortic dissections is safe but offers unclear benefit

•Analysis of 46 adjunctive false lumen embolization (FLE) with thoracic endovascular repair (TEVAR) to 838 TEVAR alone•FLE/TEVAR offers unclear benefit in patients with chronic aortic dissections:○Similar incidence of postoperative complications, re-interventions, and aortic remodeling○Trend toward improved survival and increased rates of FL thrombosis in treated thoracic segment•Further investigation needed to determine most suitable FLE implementation in chronic aortic dissections : Adjunctive false lumen embolization (FLE) with thoracic endovascular aortic repair (TEVAR) in patients with chronic aortic dissection is thought to induce FL thrombosis and favorable aortic remodeling. However, these data are derived from small single-institution experiences and the potential benefit of FLE remains unproven. In this study, we examined perioperative and midterm outcomes of patients with aortic dissection undergoing concomitant TEVAR and FLE.*⁎Thoracic endovascular aortic repair (TEVAR), false lumen embolization (FLE), false lumen (FL), vascular quality initiative (VQI), coronary artery disease (CAD), length of stay (LOS), Society for Vascular Surgery (SVS), Society of Thoracic Surgeons (STS) : Patients 18 or older who underwent TEVAR for chronic aortic dissection with known FLE status in the Society for Vascular Surgery Vascular Quality Initiative database between January 2010 and February 2020 were included. Ruptured patients and emergent procedures were excluded. Patient characteristics, operative details and outcomes were analyzed by group: TEVAR with or without FLE. Primary outcomes were in-hospital post-operative complications and all-cause mortality. Secondary outcomes included follow-up mean maximum aortic diameter change, rates of false lumen thrombosis, re-intervention rates, and mortality. 884 patients were included: 46 had TEVAR/FLE and 838 had TEVAR alone. There was no significant difference between groups in terms of age, gender, comorbidities, prior aortic interventions, mean maximum pre-operative aortic diameter (5.1cm vs. 5.0cm, P=0.43), presentation symptomatology, or intervention indication. FLE was associated with significantly longer procedural times (178min vs. 146min, P=0.0002), increased contrast use (134mL vs. 113mL, P=0.02), and prolonged fluoroscopy time (34min vs. 21min, P