Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Ann Cardiothorac Surg. 2014 May;3(3):292-9. doi: 10.3978/j.issn.2225-319X.2014.04.04.
Despite advances in surgical techniques and postoperative management, the in-hospital mortality rate for patients undergoing conventional open surgical repair for type B dissections is still significant. In light of this, the less invasive surgical procedure for acute type B aortic dissections, defined as thoracic endovascular aortic repair (TEVAR), was developed. Despite some controversy, the use of TEVAR for the management of type B aortic dissections has become commonplace. Generally, the main entry tear in type B aortic dissection is located in the vicinity of the orifice of the left subclavian artery (LSA). The proximal landing zone in the aortic arch must be secured as long as the aim of TEVAR for type B dissection is primary entry closure. This requires hybrid surgery that includes the use of open surgical procedures, such as debranching for revascularization of cervical branches. Despite the presence of challenging anatomic conditions in the aortic arch, hybrid repair has evolved as an increasingly viable alternative, and promising early and long-term results have been reported. As the next step, fenestrated and branched TEVAR techniques have recently been reported with satisfactory early results. In the coming years, there will be intense competition to develop the devices themselves, improve delivery systems, and supplement devices with auxiliary functions. Thus there is high expectations for the next generation and how they will improve and advance treatment methods of TEVAR for type B aortic dissections.
尽管手术技术和术后管理有所进步，但接受传统开放式手术修复 B 型夹层的患者的院内死亡率仍然很高。有鉴于此，开发了一种针对急性 B 型主动脉夹层的微创外科手术，即胸主动脉腔内修复术（TEVAR）。尽管存在一些争议，但 TEVAR 在 B 型主动脉夹层的治疗中已变得普遍。一般来说，B 型主动脉夹层的主要入口撕裂位于左锁骨下动脉（LSA）开口附近。只要 TEVAR 治疗 B 型夹层的目的是主要入口封闭，就必须确保主动脉弓近端的着陆区安全。这需要采用杂交手术，包括使用开放手术，如分支去分支以实现颈部分支的血运重建。尽管主动脉弓存在具有挑战性的解剖条件，但杂交修复已发展成为一种越来越可行的替代方法，并且已经报道了令人鼓舞的早期和长期结果。作为下一步，最近已经报道了开窗和分支 TEVAR 技术，具有令人满意的早期结果。在未来几年，将有激烈的竞争来开发设备本身、改进输送系统，并为设备补充辅助功能。因此，人们对下一代技术充满期待，希望它们能改进和推进 B 型主动脉夹层 TEVAR 的治疗方法。
