Chemelli-Steingruber Iris Eva, Chemelli Andreas, Strasak Alexander, Hugl Beate, Hiemetzberger Renate, Czermak Benedikt V
Department of Radiology, Innsbruck Medical University, Innsbruck, Austria.
J Vasc Surg. 2009 Jan;49(1):20-8. doi: 10.1016/j.jvs.2008.08.062. Epub 2008 Nov 4.
The aim of this retrospective study was to evaluate aortic volume changes in patients with acute type B aortic dissection (TBD), treated either by thoracic endovascular aortic repair (TEVAR) or conservatively.
From July 1996 through March 2008, 76 patients presenting with acute TBD were referred to our department. To ensure a follow-up of at least 24 months, only 64 of them were included in the present study, with the cut-off for inclusion being March 2006. Twenty-nine of these patients underwent TEVAR and 35 patients underwent conservative treatment. Indications for TEVAR were life-threatening symptoms. Follow-up was performed postinterventionally in patients after TEVAR and at 3, 6, and 12 months, and yearly thereafter in both groups. It included clinical examinations, computed tomography (CT) scans, analysis of volume changes in true thoracic lumen (TTL), false thoracic lumen (FTL), thoracic lumen (TL), abdominal lumen (AL), and aortic diameter measurements. In addition, the extent of thrombosis and its influence on volume changes were assessed.
Mean follow-up was 41 months after TEVAR and 46 months in the conservatively-treated patients. At 60 months, cumulative rates of freedom from dissection-related death and rupture-free survival were 82.6% and 93.1% in the TEVAR group, respectively. They were 74.9% and 88.5% in the conservatively-treated group, respectively. In the conservatively-treated patients, 3 patients died of late aortic rupture, 4 were converted to open surgery, and 2 to TEVAR. Evaluation of volume changes showed better results in the TEVAR group within 24 months. However, within 60 months the difference between the two groups was no longer relevant. Relating to thrombosis of the FTL, analyses showed slightly better overall results and promotion of thrombus formation after TEVAR. However, at 60 months the results showed a tendency towards approximation between the two groups.
Our data suggest that TEVAR seems to delay the natural course of the disease but not to stop it.
本回顾性研究旨在评估接受胸主动脉腔内修复术（TEVAR）或保守治疗的急性B型主动脉夹层（TBD）患者的主动脉容积变化。
1996年7月至2008年3月，76例急性TBD患者转诊至我科。为确保至少24个月的随访，本研究仅纳入其中64例，纳入截止时间为2006年3月。这些患者中29例行TEVAR，35例行保守治疗。TEVAR的指征为危及生命的症状。TEVAR术后患者在干预后进行随访，两组在术后3、6、12个月及之后每年进行随访。随访包括临床检查、计算机断层扫描（CT）、真胸段管腔（TTL）、假胸段管腔（FTL）、胸段管腔（TL）、腹段管腔（AL）容积变化分析及主动脉直径测量。此外，评估血栓形成程度及其对容积变化的影响。
TEVAR组平均随访41个月，保守治疗组平均随访46个月。60个月时，TEVAR组与夹层相关死亡和无破裂生存的累积发生率分别为82.6%和93.1%。保守治疗组分别为74.9%和88.5%。保守治疗患者中，3例死于晚期主动脉破裂，4例转为开放手术，2例转为TEVAR。容积变化评估显示，TEVAR组在24个月内效果更好。然而，60个月内两组间差异不再显著。关于FTL血栓形成，分析显示TEVAR术后总体结果略好且血栓形成增加。然而，60个月时结果显示两组有接近趋势。
我们的数据表明，TEVAR似乎可延缓疾病自然进程，但无法阻止其发展。
