Merola Jonathan, Garg Karan, Adelman Mark A, Maldonado Thomas S, Cayne Neal S, Mussa Firas F
1Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York, NY, USA.
Vasc Endovascular Surg. 2013 Oct;47(7):497-501. doi: 10.1177/1538574413495462. Epub 2013 Jul 12.
Uncomplicated type B dissections have been traditionally managed with antihypertensive therapy. In the endovascular era, this dictum has been revisited. This review pooled the available studies to compare the outcomes of best medical therapy (BMT) to thoracic endovascular aortic repair (TEVAR) for uncomplicated type B dissections.
A literature search was performed to identify studies on uncomplicated type B dissections managed with BMT with and without TEVAR. The primary outcome measures were mortality rates at 30 days and at 2 years following intervention.
A total of 6 studies included 123 patients who underwent TEVAR/BMT, and 566 patients who had BMT alone. The mortality rates at 30 days (6.5% TEVAR/BMT vs 4.8% BMT, P = .21) and at 2 years (9.7% vs 11.9%, P = .32) were similar. Renal failure was greater in TEVAR/BMT (15.4% vs 2.1%, P < .01). Rates of surgical reintervention/intervention were similar (17.6% vs 20.1%, P = .31).
The TEVAR with BMT does not provide survival benefit compared to BMT alone, 2 years following uncomplicated type B aortic dissection.
传统上，单纯性B型主动脉夹层采用降压治疗。在血管腔内治疗时代，这一原则受到了重新审视。本综述汇总了现有研究，以比较单纯性B型主动脉夹层最佳药物治疗（BMT）与胸主动脉腔内修复术（TEVAR）的疗效。
进行文献检索，以确定采用BMT联合或不联合TEVAR治疗单纯性B型主动脉夹层的研究。主要结局指标为干预后30天和2年的死亡率。
共有6项研究，其中123例患者接受了TEVAR/BMT治疗，566例患者仅接受了BMT治疗。30天死亡率（TEVAR/BMT组为6.5%，BMT组为4.8%，P = 0.21）和2年死亡率（分别为9.7%和11.9%，P = 0.32）相似。TEVAR/BMT组肾衰竭发生率更高（15.4% vs 2.1%，P < 0.01）。手术再次干预/干预率相似（17.6% vs 20.1%，P = 0.31）。
对于单纯性B型主动脉夹层，与单纯BMT相比，TEVAR联合BMT在2年时未提供生存获益。
