Usui Akihiko
Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan,
Gen Thorac Cardiovasc Surg. 2014 May;62(5):282-9. doi: 10.1007/s11748-013-0348-8. Epub 2013 Dec 10.
TEVAR is a new strategy for treating both acute and chronic type B aortic dissection. The JSC guidelines classify TEVAR as a Class I recommendation for cases of complicated acute type B dissection and a Class IIa recommendation for cases of chronic type B aortic dissection. While TEVAR has been primarily applied to treat complicated acute type B aortic dissection in Europe and the USA, the procedure remains an off-label treatment strategy for aortic dissection in Japan. The current state of TEVAR for type B aortic dissection in Japan from 2001 to 2011 is estimated in the annual reports of the Japanese Association for Thoracic Surgery. The number of acute type B aortic dissection patients treated with transluminal stent grafting increased rapidly after 2008, from 10 cases in 2001 to 76 cases in 2010. Meanwhile, the number acute type B aortic dissection patients treated with any type of surgery has increased gradually, from 100 cases in 2001 to 194 cases in 2009. The number of chronic type B aortic dissection patients treated with transluminal stent grafting increased abruptly in 2010, reaching 346 cases, which accounted for one-third of all surgical procedures for chronic type B aortic dissection. Furthermore, the number of open surgeries for chronic type B aortic dissection has also increased gradually, from 401 cases in 2001 to 947 cases in 2011. At present, open surgery, TEVAR and hybrid procedures are available to treat patients with type B aortic dissection. The use of a multidisciplinary team approach is mandatory when selecting the appropriate surgical strategy.
胸主动脉腔内修复术（TEVAR）是治疗急慢性B型主动脉夹层的一种新策略。日本循环学会（JSC）指南将TEVAR列为复杂急性B型夹层病例的I类推荐，以及慢性B型主动脉夹层病例的IIa类推荐。虽然TEVAR在欧美主要用于治疗复杂急性B型主动脉夹层，但在日本该手术仍是主动脉夹层的一种非适应证治疗策略。日本胸外科学会的年度报告对2001年至2011年日本B型主动脉夹层的TEVAR现状进行了评估。经腔内支架植入术治疗的急性B型主动脉夹层患者数量在2008年后迅速增加，从2001年的10例增至2010年的76例。与此同时，接受任何类型手术治疗的急性B型主动脉夹层患者数量逐渐增加，从2001年的100例增至2009年的194例。2010年，经腔内支架植入术治疗的慢性B型主动脉夹层患者数量突然增加，达到346例，占慢性B型主动脉夹层所有手术的三分之一。此外，慢性B型主动脉夹层的开放手术数量也逐渐增加，从2001年的401例增至2011年的947例。目前，开放手术、TEVAR和杂交手术均可用于治疗B型主动脉夹层患者。在选择合适的手术策略时，必须采用多学科团队方法。
