Department of Cardiovascular Surgery, University Hospital Berne, Switzerland.
Ann Thorac Surg. 2010 Jul;90(1):90-4. doi: 10.1016/j.athoracsur.2010.04.001.
Midterm results of TEVAR (thoracic endovascular aortic repair) in patients with aneurysms involving the descending aorta originating from chronic type B dissections are not known.
Between 2004 and 2009, 14 patients with a median age of 63 years (79% male) with this pathology were treated. Seven patients underwent supraaortic transpositions in various extents prior to TEVAR in order to gain a sufficient proximal landing zone.
Median time from dissection to treatment was 19 months (4 to 84 months). All patients had an uneventful in-hospital course. The median covered length of the aortic arch and descending aorta was 190 mm (100 to 250 mm). Primary success rate defined as absence of type Ia endoleakage was 86%. No patient, where visceral or renal vessels originated from the false or from both lumina sustained ischemic injury by TEVAR. The median follow-up period is 34 months to date (6 to 64 months). Aortic-related morbidity and mortality during follow-up was low (14%).
Midterm results of TEVAR in patients with aneurysms involving the descending aorta originating from chronic type B dissections are good. The self-expanding capability of the stent grafts is sufficient over time. However, extensive coverage of the descending aorta is warranted to achieve success. Further studies are needed to extend our knowledge in this particular subgroup of patients.
起源于慢性 B 型夹层的降主动脉动脉瘤患者行胸主动脉腔内修复术（TEVAR）的中期结果尚不清楚。
2004 年至 2009 年间，14 名年龄中位数为 63 岁（79%为男性）的此类患者接受了治疗。为了获得足够的近端锚定区，7 名患者在 TEVAR 前进行了不同程度的主动脉弓上转位。
从夹层到治疗的中位时间为 19 个月（4 至 84 个月）。所有患者均顺利度过院内治疗期。主动脉弓和降主动脉的中位覆盖长度为 190mm（100 至 250mm）。定义为不存在 I 型内漏的主要成功率为 86%。没有患者的内脏或肾血管起源于假腔或真假腔，因 TEVAR 而发生缺血性损伤。中位随访时间截至目前为 34 个月（6 至 64 个月）。随访期间主动脉相关发病率和死亡率较低（14%）。
起源于慢性 B 型夹层的降主动脉动脉瘤患者行 TEVAR 的中期结果良好。支架移植物的自膨胀能力随时间推移而充分发挥。然而，为了取得成功，需要广泛覆盖降主动脉。需要进一步的研究来扩展我们对这一特定患者亚组的认识。
