Background and Aims Thoracic endovascular aortic repair (TEVAR) has become the preferred treatment for complex aortic dissections and has been widely applied in recent years. TEVAR usually needs to cover the primary tear alone, leaving the distal tear uncovered. However, long-term follow-up has revealed that leaving the distal tear untreated can lead to a series of complications, such as aneurysmal dilatation at the distal end of stent-graft, inadequate perfusion causing visceral ischemia, and the development of new dissections at the distal end of the covered stent. Additionally, recent studies have demonstrated that the remodeling effect in the thoracic aortic segment with stent coverage is favorable after TEVAR, but the remodeling effect in the abdominal aortic segment without stent coverage is less satisfactory, potentially leading to aortic dilation or the development of dissecting aneurysms, requiring further intervention. Given the close relationship between poor abdominal aortic remodeling after TEVAR and the prognosis of patients, this study was performed to investigate the abdominal aortic remodeling following TEVAR in patients with acute or subacute Debakey IIIb aortic dissection and the potential influencing factor, so as to provide a reference for clinical practice.Methods The preoperative and one-year postoperative information as well as imaging data of patients with Debakey IIIb aortic dissection undergoing TEVAR surgery in the Second Affiliated Hospital of Nanchang University from May 2017 to May 2023 were retrospectively collected. Patients were categorized into non-remodeling and remodeling groups according to the arterial diameter of the maximum diameter plane of the abdominal aorta and the changes in the true and false lumens. Factors influencing abdominal aortic remodeling after TEVAR were analyzed.Results Based on inclusion and exclusion criteria, 105 patients were finally selected, with 44 in the non-remodeling group and 61 in the remodeling group. Results of univariate analysis showed that there were no statistically significant differences between the two groups in terms of sex, time from symptom onset to surgery, and medical history (all P>0.05); there were significant differences between the non-remodeling and remodeling groups in terms of median age (62.50 years vs. 55.00 years), average number of the distal tears (2.98 vs. 2.26), and the proportion of cases with left renal artery involvement (38.64% vs. 19.67%) (all P<0.05). Results of Multivariate Logistic regression analysis revealed that the number of distal tears was an independent risk factor for abdominal aortic remodeling after TEVAR (OR=0.589, 95% CI=0.406~0.855, P=0.005).Conclusion Following TEVAR, some patients exhibit inadequate remodeling of the abdominal aorta, and the primary factor influencing this is the number of distal tears. For those with a higher number of distal tears, close follow-up and observation of aortic remodeling are recommended, and surgical intervention may be necessary if needed.