胸主动脉覆膜支架象鼻技术治疗 B 型主动脉夹层术后真假腔容量变化
Volume changes in aortic true and false lumen after the "PETTICOAT" procedure for type B aortic dissection.
机构信息
Division of Vascular Surgery, Vita - Salute University, Scientific Institute H. San Raffaele, Milan, Italy.
出版信息
J Vasc Surg. 2012 Mar;55(3):641-51. doi: 10.1016/j.jvs.2011.10.025. Epub 2012 Jan 28.
BACKGROUND
The PETTICOAT (Provisional ExTension to Induce COmplete ATtachment) technique may be employed during endovascular treatment of type B aortic dissection (TBD) using self-expandable bare stents distal to the covered stent graft placed over the proximal entry tear. The aim of this study is to evaluate the volume changes of the true (TL) and false lumen (FL) on computed tomography (CT) scans.
METHODS
Since 2005, 25 selected patients received endovascular treatment for complicated TBD with the PETTICOAT technique employing the Zenith Dissection Endovascular System (William Cook Europe, Bjaerverskov, Denmark). Indications to the use of the PETTICOAT technique were the evidence of clinical manifest dynamic malperfusion in five cases (20%) and/or radiologic evidence of TL collapse in 20 cases (80%). Five patients were treated within 2 weeks from onset, 13 patients between 2 weeks and 3 months, and seven patients over 3 months after the initial acute event. The volumetric analysis of the changes of TL and FL obtained from CT scan performed before endovascular treatment of TBD, postoperatively and yearly thereafter were analyzed using the OsiriX software v 3.9 (Pixmeo sarl, Bernex, Switzerland).
RESULTS
Initial clinical (30 days) and midterm clinical success was observed in 21 cases (84%) and in 23 cases (92%), respectively. The volumes of the aortic TL and FL were evaluated at 30 days and midterm follow-up (mean, 38 ± 17 months). The following TL volumes were recorded: baseline 84 ± 29 cm(3), postoperative 167 ± 31 cm(3) (+98%), 1 year 193 ± 46 cm(3) (+131%), and 2 years 216 ± 54 cm(3) (+140%). The following FL volumes were recorded: baseline 332 ± 86 cm(3), postoperative 286 ± 85 cm(3) (-14%), 1 year 233 ± 81 cm(3) (-30%), and 2 years 248 ± 112 cm(3) (-32%). Progressive remodeling of the TL was recorded over time in both thoracic and abdominal segments with shrinkage of the FL mainly in the thoracic segment.
CONCLUSIONS
These data provide insight into potential therapeutic benefit of the PETTICOAT technique. A significant immediate increase in TL could be achieved with resolution of all cases of dynamic malperfusion and TL collapse. A different behavior of volumes in the thoracic and abdominal segments was observed.
背景
在使用自膨式裸支架治疗 B 型主动脉夹层（TBD）时，可在近端入口撕裂上方放置覆膜支架后，使用 PETTICOAT（临时扩展以诱导完全附着）技术在远端进行治疗。本研究旨在评估 CT 扫描中真腔（TL）和假腔（FL）的体积变化。
方法
自 2005 年以来，25 名选择的接受 Zenith 夹层血管内系统（William Cook Europe，Bjaerverskov，丹麦）治疗的复杂 TBD 患者接受了 PETTICOAT 技术治疗。使用 PETTICOAT 技术的适应证为 5 例（20%）有临床显性动态灌注不良的证据和/或 20 例（80%）有 TL 塌陷的影像学证据。5 例患者在急性事件后 2 周内接受治疗，13 例患者在 2 周至 3 个月之间接受治疗，7 例患者在 3 个月后接受治疗。使用 OsiriX 软件 v 3.9（Pixmeo sarl，Bernex，瑞士）分析 TBD 血管内治疗前、术后及此后每年进行的 CT 扫描中 TL 和 FL 变化的容积分析。
结果
21 例（84%）和 23 例（92%）患者分别在 30 天和中期临床成功。在 30 天和中期随访（平均 38 ± 17 个月）评估了主动脉 TL 和 FL 的体积。记录了以下 TL 体积：基线 84 ± 29 cm³，术后 167 ± 31 cm³（+98%），1 年 193 ± 46 cm³（+131%），2 年 216 ± 54 cm³（+140%）。记录了以下 FL 体积：基线 332 ± 86 cm³，术后 286 ± 85 cm³（-14%），1 年 233 ± 81 cm³（-30%），2 年 248 ± 112 cm³（-32%）。随着时间的推移，TL 在胸段和腹段均出现进行性重塑，FL 主要在胸段缩小。
结论
这些数据提供了对 PETTICOAT 技术潜在治疗益处的深入了解。可通过解决所有动态灌注不良和 TL 塌陷的病例来实现 TL 的即时显著增加。观察到胸段和腹段体积的不同行为。
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