Division of Vascular Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
J Vasc Surg. 2012 May;55(5):1268-75; discussion 1275-6. doi: 10.1016/j.jvs.2011.11.099. Epub 2012 Jan 17.
The long-term results of treating chronic aortic dissections and aneurysms in association with dissections with thoracic endovascular aortic repair (TEVAR) are unknown, and the timing for intervention is uncertain. We evaluated the morphology of stent graft and aorta remodeling and the volumetric changes in these patients after successful TEVAR.
Serial computed tomography scans of 32 patients who underwent TEVAR for uncomplicated chronic dissections (group A, n = 17) and chronic dissections with aneurysms (group B, n = 15) were analyzed at 1, 6, 12, and 36 months. Stent graft diameter changes and positional migration were assessed three-dimensionally using Mimics 14.0 (Materialize, Leuven, Belgium). Volumetric data for true lumen, false lumen, thrombus load, and aortic size were measured by Aquarius iNtuition 4.4 software (TeraRecon, San Mateo, Calif). Results were compared between the two groups and with stent graft diameter, length, and oversizing.
Aortic stent grafts remodeled progressively, with inlet area increasing 4.4%, 10.1%, and 14.2% and outlet area increasing 42.6%, 67.2%, and 72.3%, respectively, at 6, 12, and 36 months. True lumen volume increased progressively in group A (114 to 174 mL) and group B (124 to 190 mL) from baseline to 36 months. False lumen volume decreased in group A (150 to 88 mL) and group B (351 to 250 mL), whereas thrombus load in the false lumen increased from 73% to 80% in group A and 84% to 87% in group B in 3 years. Eight patients (4 in each group) showed an increase in total aortic volume of >10%, 12 showed a static volume, and 12 showed shrinkage. Aortic volume change had no relationship to pathology, stent graft sizing, and thrombus load but was positively associated with the placement of a longer graft. A small but progressive distal migration of stent grafts was noted in all patients (3.1, 4.5, and 5.1 mm at 6, 12, and 36 months) but was more prominent in shorter stent grafts (≤ 162 mm). No deaths, rupture, or secondary interventions occurred during follow-up.
Aortic remodeling after TEVAR in chronic dissection is a continuous process. There were no significant differences between chronic dissections and aneurysms in all volumetric parameters. Treating chronic dissections early, before aneurysm formation, did not appear to have a morphologic advantage.
经胸主动脉腔内修复术（TEVAR）治疗慢性主动脉夹层和夹层相关动脉瘤的长期结果尚不清楚，干预时机也不确定。我们评估了成功 TEVAR 后支架移植物和主动脉重塑的形态以及这些患者的体积变化。
对 32 例接受 TEVAR 治疗的非复杂性慢性夹层（A 组，n = 17）和慢性夹层合并动脉瘤（B 组，n = 15）患者的连续 CT 扫描，分别在 1、6、12 和 36 个月时进行分析。使用 Mimics 14.0（Materialize，Leuven，比利时）三维评估支架移植物直径变化和位置迁移。使用 Aquarius iNtuition 4.4 软件（TeraRecon，San Mateo，加利福尼亚）测量真腔、假腔、血栓负荷和主动脉大小的容积数据。将两组之间以及与支架移植物直径、长度和过度扩张进行比较。
主动脉支架移植物逐渐重塑，入口面积分别增加 4.4%、10.1%和 14.2%，出口面积分别增加 42.6%、67.2%和 72.3%，分别在 6、12 和 36 个月时。A 组（114 至 174 mL）和 B 组（124 至 190 mL）的真腔体积从基线到 36 个月时逐渐增加。A 组（150 至 88 mL）和 B 组（351 至 250 mL）的假腔体积减少，而 3 年内 A 组（73%至 80%）和 B 组（84%至 87%）的假腔血栓负荷增加。8 名患者（每组 4 名）的总主动脉体积增加超过 10%，12 名患者的体积保持不变，12 名患者的体积缩小。主动脉体积变化与病理学、支架移植物大小和血栓负荷无关，但与放置更长的移植物呈正相关。所有患者的支架移植物均有轻微但逐渐的远端迁移（6、12 和 36 个月时分别为 3.1、4.5 和 5.1 mm），但较短的支架移植物（≤ 162 mm）更为明显。在随访期间，没有死亡、破裂或二次干预。
慢性夹层 TEVAR 后的主动脉重塑是一个持续的过程。在所有容积参数方面，慢性夹层和夹层相关动脉瘤之间没有显著差异。在动脉瘤形成之前尽早治疗慢性夹层似乎没有形态学优势。
