Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
Department of Interventional Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian, China.
J Am Coll Cardiol. 2016 Jun 21;67(24):2835-42. doi: 10.1016/j.jacc.2016.03.578.
Thoracic endovascular aortic repair (TEVAR) has been used in patients with uncomplicated type B acute aortic dissection (B-AAD) to reduce late morbidity and mortality. The outcomes of comparisons between TEVAR and best medical treatment (BMT) on patients with uncomplicated type B-AAD are inconsistent in the published reports.
This study sought to further clarify the early and long-term (11-year) outcomes of TEVAR in patients with uncomplicated type B-AAD compared with those with BMT treatment.
Between February 2003 and August 2014, 338 patients with uncomplicated type B-AAD were retrospectively identified in 3 tertiary medical centers. Information about baseline characteristics was collected from medical records. Images were retrieved from the imaging archiving system, and the thrombosis status of the false lumen and extent of the dissection were evaluated via computed tomography angiography. Early and late outcomes were recorded and analyzed.
TEVAR procedures were performed on 184 patients (TEVAR group) and BMT for 154 patients (BMT group). Early events and 30-day mortality were not significantly different between the 2 groups. Patients receiving BMT had significantly higher aortic-related adverse events compared with those in the TEVAR group (p = 0.025). All-cause mortality with TEVAR was significantly lower than that of BMT (p = 0.01).
This study confirmed the feasibility of TEVAR for uncomplicated type B aortic dissection in the acute setting with fewer aortic-related adverse events and a lower mortality rate compared with BMT.
胸主动脉腔内修复术（TEVAR）已被用于治疗单纯性 B 型急性主动脉夹层（B-AAD）患者，以降低晚期发病率和死亡率。在已发表的报告中，TEVAR 与最佳药物治疗（BMT）治疗单纯性 B-AAD 患者的结果并不一致。
本研究旨在进一步阐明与 BMT 治疗相比，TEVAR 在单纯性 B-AAD 患者中的早期和长期（11 年）结局。
在 3 家三级医疗中心，回顾性地确定了 338 例单纯性 B-AAD 患者。从病历中收集基线特征信息。从影像归档系统中检索图像，并通过计算机断层血管造影评估假腔的血栓形成状态和夹层的程度。记录和分析早期和晚期结果。
184 例患者（TEVAR 组）接受了 TEVAR 手术，154 例患者（BMT 组）接受了 BMT。两组间早期事件和 30 天死亡率无显著差异。接受 BMT 的患者与 TEVAR 组相比，主动脉相关不良事件明显更高（p=0.025）。TEVAR 的全因死亡率明显低于 BMT（p=0.01）。
本研究证实了在急性情况下对单纯性 B 型主动脉夹层进行 TEVAR 的可行性，与 BMT 相比，TEVAR 具有较少的主动脉相关不良事件和较低的死亡率。
