Division of Vascular and Endovascular Surgery, Harbor UCLA Medical Center, Torrance, CA, USA.
J Vasc Surg. 2011 Aug;54(2):316-24; discussion 324-5. doi: 10.1016/j.jvs.2010.11.134.
Structural changes within the aorta after thoracic endovascular aortic repair (TEVAR) for acute complicated type B thoracic aortic dissections (ABAD) remain unknown. This study reviewed and analyzed morphologic changes, volumetric data, and clinical outcomes of patients with ABAD.
Forty-one consecutive patients with ABAD, all with the volumetric analysis of aortic luminal changes and ≥1 year of follow-up, were treated as a part of a single-center U.S. Food and Drug Administration (FDA)-approved investigational device exemption (IDE) trial from 2002 to 2009. Indications were malperfusion in 17, rupture in 12, chest pain in 6, acute enlargement in 4, and uncontrolled hypertension in 2. Duration of symptoms was ≤14 days. Three-dimensional M2S computed tomography reconstructions (Medical MetRx Solutions, West Lebanon, NH) were analyzed for aortic volume and diameter changes, regression of the false lumen, and expansion of the true lumen.
Emergent surgery was required in 17 (42%) patients, excluding one death at induction. Procedural success rate was 92.5%. The 30-day mortality was 4.9% for malperfusion, 4.9% for rupture, and 0% for all others, with late mortality of 0%, 9.8%, and 7.3%, respectively. Mean follow-up was 12.4 months. Permanent stroke and paraplegia rates were 4.9% (n = 2) and 0%. Ten of 12 secondary interventions were performed for 6 proximal endoleaks, 1 distal cuff endoleak, and 3 distal reperfusions. For the 33 patients without endoleaks, the true lumen volume increased by 29% at 1 month, 51% at 1 year, and 80% at 5 years. Volume regression of the false lumen was 69%, 76%, and 86%, respectively. The true lumen volume did not change at 1 month or 1 year in the endoleak group (n = 7) but increased 50% at 2 years after secondary intervention. A 10% reduction of abdominal aortic volume distal to endograft occurred over 5 years in the absence of endoleaks.
TEVAR offers a promising solution to patients with ABAD. Aortic morphologic changes occur shortly after TEVAR and remain predictable up to 5 years with continuous expansion of the true lumen and regression of the false lumen. A lack of increase in the true lumen volume is associated with endoleaks or distal reperfusion.
胸主动脉腔内修复术（TEVAR）治疗急性复杂型 B 型主动脉夹层（ABAD）后主动脉结构的变化尚不清楚。本研究回顾性分析了 ABAD 患者的形态学变化、容量数据和临床结果。
2002 年至 2009 年，41 例 ABAD 患者连续入组，均接受了主动脉管腔变化的容量分析，并进行了至少 1 年的随访。这是美国食品和药物管理局（FDA）批准的一项单中心研究性器械豁免（IDE）试验的一部分。适应证为 17 例灌注不良、12 例破裂、6 例胸痛、4 例急性扩张和 2 例未控制的高血压。症状持续时间≤14 天。对三维 M2S 计算机断层扫描重建（Medical MetRx Solutions，West Lebanon，NH）进行分析，以评估主动脉容量和直径变化、假腔的消退以及真腔的扩张。
17 例（42%）患者需要紧急手术，诱导期除外 1 例死亡。手术成功率为 92.5%。灌注不良、破裂的 30 天死亡率分别为 4.9%和 4.9%，其他所有患者的死亡率为 0%，晚期死亡率分别为 0%、9.8%和 7.3%。平均随访时间为 12.4 个月。永久性卒中率和截瘫率分别为 4.9%（n=2）和 0%。12 例继发性干预中有 10 例用于治疗 6 例近端内漏、1 例远端袖口内漏和 3 例远端再灌注。对于 33 例无内漏患者，真腔体积在 1 个月时增加了 29%，在 1 年时增加了 51%，在 5 年时增加了 80%。假腔的体积消退率分别为 69%、76%和 86%。内漏组（n=7）在 1 个月和 1 年内真腔体积没有变化，但在 2 年内接受二次干预后增加了 50%。在没有内漏的情况下，5 年内腹主动脉下段体积减少了 10%。
TEVAR 为 ABAD 患者提供了一种很有前途的治疗方法。TEVAR 后主动脉形态学变化很快，在 5 年内可通过真腔的持续扩张和假腔的消退来预测。真腔体积的增加与内漏或远端再灌注有关。
