Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan Medical Center, B1 132G Taubman Center/5302, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-5030, USA.
J Vasc Interv Radiol. 2012 Jul;23(7):859-865.e3. doi: 10.1016/j.jvir.2012.03.012. Epub 2012 May 19.
To document the natural history of branch artery pseudoaneurysms (BAPs), which are sequelae of aortic dissection with false lumen thrombosis that have been distinguished anatomically from penetrating ulcers.
Serial computed tomography (CT) scans in 50 patients with at least two CT scans greater than 1 month apart were retrospectively studied. Mean follow-up was 29 months, with longitudinal analyses of 119 BAPs. Changes in BAPs, false lumen thrombosis, and aortic diameter were assessed.
No patient had an aortic rupture or other poor outcome. All BAPs eventually disappeared (ie, thrombosed), with 50% thrombosed within 18 months. Aortas were ectatic, with a mean diameter of 36 mm. There was no statistically significant change in total aortic diameters; however, there was a significant increase in true lumen diameters (P < .0001) and a significant decrease in false lumen thickness (P < .0001) at the level of the BAP over time (mean 50% reduction in maximum thickness of thrombosed false lumen). There were no significant associations between BAP thrombosis and vertebral level, presence of more than one BAP, presence of branch artery in communication with the BAP, history of smoking, diabetes mellitus or hypertension, or treatment with β-blockers, other antihypertensive medication, statins, or anticoagulation therapy. After controlling for other variables, BAPs were less likely to thrombose if an ulcerlike projection was present (P = .003), in men (P = .02), in subjects with hypertension (P = .04), and in older patients (P = .05).
Most BAPs spontaneously thrombose, and associated intramural hematoma regresses/disappears. Isolated BAPs were not associated with poor clinical outcomes.
记录分支动脉假性动脉瘤（BAP）的自然病史，这些动脉瘤是主动脉夹层伴假腔血栓形成的后遗症，在解剖学上与穿透性溃疡区分开来。
回顾性研究了 50 例至少有两次 CT 扫描时间间隔超过 1 个月的患者的连续 CT 扫描。平均随访时间为 29 个月，对 119 个 BAP 进行了纵向分析。评估 BAP、假腔血栓形成和主动脉直径的变化。
没有患者发生主动脉破裂或其他不良结局。所有 BAP 最终都消失（即血栓形成），50%在 18 个月内血栓形成。主动脉呈扩张性，平均直径为 36mm。总主动脉直径没有统计学上的显著变化；然而，随着时间的推移，BAP 水平的真腔直径显著增加（P <.0001），假腔厚度显著减少（P <.0001）（血栓形成的假腔最大厚度平均减少 50%）。BAP 血栓形成与椎体水平、存在多个 BAP、分支动脉与 BAP 相通、吸烟史、糖尿病或高血压病史、β受体阻滞剂、其他降压药物、他汀类药物或抗凝治疗之间无显著相关性。在控制其他变量后，如果存在溃疡性突起（P =.003）、男性（P =.02）、高血压患者（P =.04）和老年患者（P =.05），BAP 更不可能血栓形成。
大多数 BAP 自发血栓形成，伴发的壁内血肿消退/消失。孤立的 BAP 与不良临床结局无关。
