Song Suk-Won, Kim Tae Hoon, Lim Sun-Hee, Lee Kwang-Hun, Yoo Kyung-Jong, Cho Bum-Koo
Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Interventional Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Thorac Cardiovasc Surg. 2014 Sep;148(3):925-32, 933.e1; discussion 932-3. doi: 10.1016/j.jtcvs.2014.05.040. Epub 2014 May 21.
The use of thoracic endovascular aortic repair (TEVAR) for chronic DeBakey III type b (CDIIIb) aneurysms is controversial. We analyzed the potential prognostic factors affecting aorta remodeling after this procedure.
A total of 20 patients with CDIIIb aneurysms underwent TEVAR, with full coverage of reentry tears at the descending thoracic aorta. The potential factors affecting false lumen (FL) remodeling were analyzed, including reentry tears (communicating channels visible on the computed tomography angiogram), large intimal tears below the stent graft (≥ 2 consecutive axial cuts on the computed tomography angiogram), visceral branches arising from the FL, and intercostal arteries (ICAs) arising from the FL.
All the patients had uneventful in-hospital courses; 2 patients (10%) required reintervention during the follow-up period. Thirteen patients (65%) had complete thrombosis of the FL at stent graft segment. Compared with the complete thrombosis group, the partial thrombosis group had more reentry tears (1.8 vs 2.3, P = .48), large intimal tears (0.8 vs 1.7, P < .05), visceral branches arising from the FL (1.2 vs 2.3, P < .05), and ICAs arising from the FL (3.8 vs 5.1, P = .35). Reentry tears, visceral branches, and ICAs from the FL were significant negative prognostic factors for FL shrinkage (P < .05).
Although reentry tears above the celiac trunk were fully covered, the visceral branches and ICAs from the FL and all communicating channels below the celiac trunk kept the FL pressurized and were unfavorable prognostic factors for aorta remodeling after TEVAR for CDIIIb aneurysms.
胸主动脉腔内修复术（TEVAR）用于治疗慢性DeBakey III型b（CDIIIb）主动脉瘤存在争议。我们分析了该手术后影响主动脉重塑的潜在预后因素。
共有20例CDIIIb主动脉瘤患者接受了TEVAR治疗，降主动脉再入口撕裂均被完全覆盖。分析了影响假腔（FL）重塑的潜在因素，包括再入口撕裂（计算机断层扫描血管造影上可见的交通通道）、支架移植物下方的大内膜撕裂（计算机断层扫描血管造影上连续≥2个轴向层面）、起源于FL的内脏分支以及起源于FL的肋间动脉（ICA）。
所有患者住院过程均顺利；2例患者（10%）在随访期间需要再次干预。13例患者（65%）的支架移植物段FL完全血栓形成。与完全血栓形成组相比，部分血栓形成组有更多的再入口撕裂（1.8对2.3，P = 0.48）、大内膜撕裂（0.8对1.7，P < 0.05）、起源于FL的内脏分支（1.2对2.3，P < 0.05）以及起源于FL的ICA（3.8对5.1，P = 0.35）。FL的再入口撕裂、内脏分支和ICA是FL缩小的显著负性预后因素（P < 0.05）。
尽管腹腔干上方的再入口撕裂被完全覆盖，但FL的内脏分支和ICA以及腹腔干下方的所有交通通道使FL保持压力，是CDIIIb主动脉瘤TEVAR术后主动脉重塑的不良预后因素。
