Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Ann Thorac Surg. 2013 Mar;95(3):914-21. doi: 10.1016/j.athoracsur.2012.09.053. Epub 2012 Dec 13.
The efficacy of endovascular treatment of aneurysms secondary to chronic DeBakey type III aortic dissection (CD3) remains controversial. The objective of this study was to compare outcomes from open and endovascular treatment of CD3 aneurysms, and to determine the efficacy of thoracic endovascular aortic repair (TEVAR) in remodeling the chronically dissected thoracoabdominal aorta.
From 2005 to 2012, 58 patients underwent open aortic replacement (open) and 31 patients underwent endovascular therapy (TEVAR) for the treatment of CD3 aneurysms. The TEVAR patients were divided into CD3a (n = 12) or CD3b (n = 19) subgroups based upon the DeBakey classification of aortic dissection. Total aortic, true and false lumen diameters were measured at different anatomic locations. True lumen and false lumen indices were calculated to evaluate the impact of TEVAR on remodeling.
In the open group, operative mortality was 10.3% and the incidence of pulmonary failure, renal failure, and paraplegia was 13.8%, 10.3%, and 12.1%, respectively. There were no operative mortalities in TEVAR patients, and no cases of pulmonary failure, renal failure, or paraplegia. Endovascular therapy stabilized aneurysm size and remodeled the thoracic aorta in 87% of patients. The TEVAR significantly expanded the true lumen and reduced the false lumen within the stent graft in CD3a and CD3b patients (p < 0.001). Thoracic false lumen thrombosis was achieved in 100% of CD3a and in 68% of CD3b patients.
In these early results, TEVAR reduces operative morbidity and mortality compared with open aortic replacement in the treatment of CD3 aneurysms. The TEVAR is effective in remodeling the chronically dissected thoracic aorta. Abdominal false lumen patency is maintained in patients with thoracoabdominal dissection-related aneurysms.
慢性 DeBakey Ⅲ型主动脉夹层（CD3）继发动脉瘤的血管内治疗效果仍存在争议。本研究旨在比较开放手术和血管内治疗 CD3 动脉瘤的结果，并确定胸主动脉腔内修复术（TEVAR）在重塑慢性夹层胸腹主动脉中的疗效。
2005 年至 2012 年，58 例患者接受了开放主动脉置换术（开放），31 例患者接受了胸主动脉腔内修复术（TEVAR）治疗 CD3 动脉瘤。根据主动脉夹层的 DeBakey 分类，将 TEVAR 患者分为 CD3a（n = 12）或 CD3b（n = 19）亚组。在不同解剖部位测量总主动脉、真腔和假腔直径。计算真腔和假腔指数以评估 TEVAR 对重塑的影响。
在开放组中，手术死亡率为 10.3%，肺衰竭、肾衰竭和截瘫的发生率分别为 13.8%、10.3%和 12.1%。TEVAR 患者无手术死亡，无肺衰竭、肾衰竭或截瘫病例。血管内治疗稳定了动脉瘤大小，并使 87%的患者重塑了胸主动脉。TEVAR 显著扩大了 CD3a 和 CD3b 患者支架内的真腔并减少了假腔（p < 0.001）。100%的 CD3a 患者和 68%的 CD3b 患者实现了胸主动脉假腔血栓形成。
在这些早期结果中，TEVAR 与开放主动脉置换术相比，降低了 CD3 动脉瘤的手术发病率和死亡率。TEVAR 可有效重塑慢性夹层胸主动脉。在与胸腹主动脉夹层相关的动脉瘤患者中，维持了腹主动脉假腔通畅。
