Department of Cardiothoracic Surgery, Division of Cardiovascular and Interventional Radiology, University of Vienna, Vienna, Austria.
Ann Thorac Surg. 2010 Nov;90(5):1444-8. doi: 10.1016/j.athoracsur.2010.06.076.
The purpose of this study was to assess the efficacy and midterm results of endovascular treatment of acute, complicated type B aortic dissection.
Between January 2001 and February 2010, 32 patients (7 women, 25 men) with acute, complicated type B aortic dissection (mean age, 56 years; range, 35 to 83 years), defined as either aortic rupture, malperfusion, intractable pain, or uncontrolled hypertension, underwent endovascular stent graft placement with either the Gore Excluder/TAG device (n = 11), Medtronic Talent/Valiant device (n = 16), Bolton Relay (n = 2), or a combination of these stents (n = 3). Follow-up was 94% complete and averaged 26 ± 23 months.
Technical feasibility and success with deployment proximal to the entry tear was 87%, requiring partial or total coverage of the left subclavian artery (LSA) in 9 patients (28%). Hospital mortality was 12% ± 11% (95% confidence limit) with 2 late deaths (17 and 98 months after implant). Causes of hospital death included rupture in 2, retrograde type A dissection in 1, and multiorgan failure in 1 patient. Three patients (11%) experienced new neurologic complications (2 paraparesis and 1 hemiparesis). Six patients with malperfusion required branch vessel stenting. Furthermore, 2 had an early type Ia endoleak. Actuarial survival at 1 and 5 years was 81% and 76%, respectively. Freedom from treatment failure at 1 and 5 years (including reintervention, aortic rupture, device-related complication, and aortic related death) was 78% and 61%, respectively.
Endovascular stent-graft placement in acute, complicated type B aortic dissection proves to be a promising alternative therapeutic treatment modality in this relatively difficult patient cohort. Refinements, especially in stent design and application, may further improve the prognosis of patients in this life-threatening situation.
本研究旨在评估腔内治疗急性复杂型 B 型主动脉夹层的疗效和中期结果。
2001 年 1 月至 2010 年 2 月，32 例（7 名女性，25 名男性）急性复杂型 B 型主动脉夹层患者（平均年龄 56 岁；范围 35 岁至 83 岁）接受了腔内支架移植物置入术，定义为主动脉破裂、血运不良、难以控制的疼痛或高血压，使用 Gore Excluder/TAG 装置（n=11）、Medtronic Talent/Valiant 装置（n=16）、Bolton Relay（n=2）或这些支架的组合（n=3）。随访率为 94%，平均随访时间为 26±23 个月。
技术可行性和近端入路撕裂处的支架移植物成功置入率为 87%，9 例（28%）需要部分或完全覆盖左锁骨下动脉（LSA）。院内死亡率为 12%±11%（95%置信区间），2 例死亡发生于术后 17 个月和 98 个月。院内死亡的原因包括 2 例破裂、1 例逆行性 A 型夹层和 1 例多器官衰竭。3 例（11%）患者出现新发神经系统并发症（2 例截瘫和 1 例偏瘫）。6 例血运不良患者需要分支血管支架置入。此外，2 例患者发生早期 Ia 型内漏。1 年和 5 年的生存率分别为 81%和 76%。1 年和 5 年无治疗失败率（包括再次干预、主动脉破裂、器械相关并发症和主动脉相关死亡）分别为 78%和 61%。
在急性复杂型 B 型主动脉夹层中，腔内支架移植物置入术是一种很有前途的治疗方法，尤其是在这个有生命危险的患者群体中。支架设计和应用的改进可能会进一步改善此类患者的预后。
