Guo Baolei, Hou Kai, Guo Daqiao, Xu Xin, Shi Zhenyu, Shan Yan, Lv Peng, Fu Weiguo
Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
J Vasc Surg. 2017 Oct;66(4):1007-1017. doi: 10.1016/j.jvs.2016.12.145. Epub 2017 Apr 5.
Clinical outcomes after thoracic endovascular aortic repair (TEVAR) for patients with multichanneled aortic dissection (MCAD) are poorly understood but seem substantially different from those for patients with double-channeled aortic dissection (AD). This study compared the anatomic and clinical factors for patients with MCAD who underwent TEVAR with or without full true lumen (TL) collapse.
From January 2012 to March 2016, 54 of 644 consecutive type B AD patients (8.4%) who presented with MCAD were reviewed. Patients were classified as MCAD with full TL collapse and without full TL collapse according to computed tomography angiography findings. We analyzed potential variables including clinical characteristics, anatomic morphologic features, and procedural details. Multivariable analysis was performed to determine independent predictors of AD-related deaths.
A total of four patients (7.4%) died preoperatively of aortic rupture, all of whom experienced full TL collapse. MCAD patients with full TL collapse showed significantly higher 30-day major adverse events than those without full TL collapse (36.8% vs 9.7%; P = .030). The mean follow-up duration was 25.6 ± 13.2 months (range, 3-53 months). The overall mortality for all MCAD patients was 16.7%, whereas the follow-up major adverse events rate was 40.0% after TEVAR. Significant differences were present between patients with full TL collapse and patients without full TL collapse in survival at 3 years (55.4% vs 94.7%; P = .002). Maximum diameter of affected aorta (hazard ratio, 1.176; 95% confidence interval, 1.015-1.362; P = .031) was identified as the only predictor of AD-related deaths.
MCAD was identified in a small but not insignificant number of our patients presenting with type B AD. Urgent or elective TEVAR was indicated in all our patients with MCAD. In patients with MCAD, full TL collapse was associated with worse outcomes, and this finding may indicate the need for more urgent or emergent repair.
对于多腔主动脉夹层（MCAD）患者，胸主动脉腔内修复术（TEVAR）后的临床结局了解较少，但似乎与双腔主动脉夹层（AD）患者的结局有很大不同。本研究比较了接受TEVAR的MCAD患者有无真腔（TL）完全塌陷的解剖学和临床因素。
回顾2012年1月至2016年3月期间连续收治的644例B型AD患者中54例（8.4%）合并MCAD的患者。根据计算机断层扫描血管造影结果，将患者分为TL完全塌陷的MCAD患者和TL未完全塌陷的MCAD患者。我们分析了潜在变量，包括临床特征、解剖形态特征和手术细节。进行多变量分析以确定AD相关死亡的独立预测因素。
共有4例患者（7.4%）术前死于主动脉破裂，均经历了TL完全塌陷。TL完全塌陷的MCAD患者30天主要不良事件发生率显著高于TL未完全塌陷的患者（36.8%对9.7%；P = 0.030）。平均随访时间为25.6±13.2个月（范围3 - 53个月）。所有MCAD患者的总死亡率为16.7%，而TEVAR术后随访期间主要不良事件发生率为40.0%。TL完全塌陷的患者与TL未完全塌陷的患者在3年生存率方面存在显著差异（55.4%对94.7%；P = 0.002）。受累主动脉的最大直径（风险比，1.176；95%置信区间，1.015 - 1.362；P = 0.031）被确定为AD相关死亡的唯一预测因素。
在我们收治的少数B型AD患者中发现了MCAD，但数量并非微不足道。所有MCAD患者均需进行紧急或择期TEVAR。在MCAD患者中，TL完全塌陷与更差的结局相关，这一发现可能表明需要更紧急或急诊修复。
