1 Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy ; 2 Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands ; 3 The Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands ; 4 Department of Cardiac Surgery, University of Michigan Cardiovascular Center, Ann Arbor, MI, USA ; 5 Department of Cardiothoracic Surgery, University of Zurich, Switzerland.
Ann Cardiothorac Surg. 2014 May;3(3):285-91. doi: 10.3978/j.issn.2225-319X.2014.05.01.
Patients with uncomplicated acute type B aortic dissection (ABAD) can generally be treated with conservative medical management. However, these patients may develop aortic enlargement during follow-up, with the risk of rupture. Several predictors have been studied in recent years to identify ABAD patients at high risk of aortic enlargement, who may benefit from early surgical or endovascular intervention. This study reviewed and summarized the current available literature on prognostic variables related to aortic enlargement during follow-up in uncomplicated ABAD patients. It revealed multiple factors affecting aortic expansion including demographic, clinical, pharmacologic and radiologic variables. Such predictors may be used to identify those ABAD patients at higher risk for aortic enlargement who may benefit from closer radiologic surveillance or early endovascular intervention. This approach deserves even more consideration because a significant number of patients develop aneurysmal degeneration along the dissected segments during follow-up, and may lose the opportunity for endovascular treatment if not identified at an early stage.
未经复杂处理的急性 B 型主动脉夹层（ABAD）患者一般可采用保守的医学管理方法进行治疗。然而，这些患者在随访期间可能会出现主动脉增大，从而增加破裂的风险。近年来，已有多项预测因子研究旨在识别具有主动脉增大高风险的 ABAD 患者，这些患者可能受益于早期手术或血管内介入治疗。本研究回顾并总结了目前关于未经复杂处理的 ABAD 患者随访期间主动脉增大相关预后变量的现有文献。研究揭示了多种影响主动脉扩张的因素，包括人口统计学、临床、药理学和影像学变量。这些预测因子可用于识别那些主动脉增大风险较高的 ABAD 患者，他们可能需要更密切的影像学监测或早期血管内介入治疗。这种方法值得进一步考虑，因为在随访期间，大量患者沿夹层段出现动脉瘤样退行性变，如果不能在早期发现，可能会失去血管内治疗的机会。
