Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Middle Ren-Min Road No.139, Changsha, Hunan 410011, China.
Eur J Vasc Endovasc Surg. 2011 Oct;42(4):448-53. doi: 10.1016/j.ejvs.2011.05.013.
To analyse the experience of a single centre and evaluate the early and mid-term results of endovascular repair of complicated acute type B aortic dissection with stentgrafts.
From July 2002 to January 2009, 45 patients (12 women, 33 men) with complicated acute type B aortic dissection (mean age, 42.6 years; range, 31-47 years) were treated with Thoracic Endovascular Aortic Repair (TEVAR). Indications for treatment included rupture in 6(13%), hemathorax with impending rupture in 27(60%), malperfusion syndrome in 11 (22%), and transient paraplegia in one patient (2.2%). Five kinds of commercially available thoracic stentgrafts were used. Follow up was 100% during a period of 13 months (range, 1-36 months).
Technical success (coverage of the primary tear site) was achieved in all 45 patients(100%) including deliberate partial or total coverage of the LSA in 7 patients (15.6%). The 30-day and in-hospital mortality was 4.4% including one late rupture case. Overall survival was 95.6% at 1 and 3-years' follow-up. None of the patients with malperfusion required adjunct distal stents All hemothoces resolved within 3 months including 5 patient required thoracentesis and one had tube thoracostomy. And 7 patients required temporary dialysis In-hospital complications occurred in 26.7% of patients and re-intervention was required in one patient and no patient had postoperative paraplegia Postoperative CT angiography showed 25 patients (58.1%) with complete thrombosis of the false lumen and re-expansion of the true lumen.
Endovascular repair of complicated acute type B aortic dissection with stentgraft is proven to be a technically feasible and effective in this relatively difficult patient cohort, The short and mid-term efficacy are persuasive, however, the long-term efficacy needs to be evaluated further.
分析单中心经验，评估支架型主动脉腔内修复术治疗复杂急性 B 型主动脉夹层的早期和中期结果。
2002 年 7 月至 2009 年 1 月，45 例（12 例女性，33 例男性）复杂急性 B 型主动脉夹层患者（平均年龄 42.6 岁；范围 31-47 岁）接受了胸主动脉腔内修复术（TEVAR）治疗。治疗指征包括 6 例（13%）破裂、27 例（60%）即将破裂的血胸、11 例（22%）灌注不良综合征和 1 例（2.2%）一过性截瘫。使用了 5 种市售的胸主动脉支架。随访 100%，随访时间 13 个月（1-36 个月）。
45 例患者（100%）均达到技术成功（覆盖主要撕裂部位），包括 7 例（15.6%）故意部分或完全覆盖左锁骨下动脉。30 天和住院死亡率为 4.4%，包括 1 例迟发性破裂病例。1 年和 3 年随访的总体生存率分别为 95.6%。所有灌注不良的患者均无需辅助远端支架。所有血胸均在 3 个月内消退，包括 5 例需要胸腔穿刺和 1 例需要胸腔引流。7 例需要临时透析。26.7%的患者发生院内并发症，1 例需要再次介入，无患者发生术后截瘫。术后 CT 血管造影显示 25 例（58.1%）假腔完全血栓形成，真腔再扩张。
在这一相对困难的患者群体中，支架型主动脉腔内修复术治疗复杂急性 B 型主动脉夹层被证明在技术上是可行和有效的。短期和中期疗效令人信服，但长期疗效需要进一步评估。
