Zhu Ting, Si Yi, Fang Yuan, Chen Bin, Yang Jue, Jiang Junhao, Yue Jianing, Fu Weiguo
Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
J Vasc Surg. 2017 Dec;66(6):1644-1652. doi: 10.1016/j.jvs.2017.04.050. Epub 2017 Jul 8.
The objective of this study was to evaluate the safety, efficacy, and outcomes of the conformable thoracic endograft (Conformable TAG Thoracic Endoprosthesis [CTAG]; W. L. Gore & Associates, Flagstaff, Ariz) for acute complicated and uncomplicated type B aortic dissection (TBAD).
Between February and October 2016, 52 consecutive patients with acute complicated or uncomplicated TBAD were treated with a CTAG device. We assessed safety, complications, and device conformability using intraoperative angiography and computed tomography angiography. The mean follow-up period was 8.2 ± 3.5 months (range, 4-12 months).
All patients survived through the follow-up period. No endoleaks, retrograde aortic dissection, distal new entry tear, stroke, or paraplegia was observed postoperatively. Two patients (3.8%) experienced minor wound hematomas without further treatment. Eleven patients (21.2%) underwent a chimney technique to rebuild supra-arch vessels. A bird-beak configuration was observed in seven (13.5%) patients, five of whom underwent a chimney technique. Analysis of aortic remodeling showed that the minimal true lumen area significantly increased in both complicated and uncomplicated acute TBAD (P < .001 and P = .047, respectively). Likewise, the maximal false lumen area significantly decreased in uncomplicated dissection (P = .006), but no change in maximal false lumen area was detected in complicated dissection (P = .32).
Early outcomes indicate that the CTAG device provides reliable clinical effectiveness and excellent conformability in treating acute complicated and uncomplicated TBAD without risk of major complications. Studies with larger sample sizes and longer follow-up periods are required to evaluate longer term outcomes.
本研究的目的是评估适形胸主动脉内移植物（适形TAG胸主动脉内假体[CTAG]；美国亚利桑那州弗拉格斯塔夫市的W.L.戈尔联合公司）治疗急性复杂和非复杂B型主动脉夹层（TBAD）的安全性、有效性及预后情况。
2016年2月至10月期间，连续52例急性复杂或非复杂TBAD患者接受了CTAG装置治疗。我们使用术中血管造影和计算机断层扫描血管造影评估安全性、并发症及装置贴合性。平均随访期为8.2±3.5个月（范围4 - 12个月）。
所有患者在随访期内存活。术后未观察到内漏、逆行性主动脉夹层、远端新破口撕裂、中风或截瘫。2例患者（3.8%）出现轻微伤口血肿，未进一步治疗。11例患者（21.2%）采用烟囱技术重建弓上血管。7例患者（13.5%）观察到鸟嘴样形态，其中5例接受了烟囱技术。主动脉重塑分析显示，复杂和非复杂急性TBAD的最小真腔面积均显著增加（分别为P <.001和P =.047）。同样，非复杂夹层的最大假腔面积显著减小（P =.006），但复杂夹层中最大假腔面积未检测到变化（P =.32）。
早期结果表明，CTAG装置在治疗急性复杂和非复杂TBAD方面提供了可靠的临床疗效和良好的贴合性，且无重大并发症风险。需要进行更大样本量和更长随访期的研究来评估长期预后。
