Zhang Min-Hong, Du Xin, Guo Wei, Liu Xiao-Ping, Jia Xin, Ge Yang-Yang
Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing, China.
Medicine (Baltimore). 2017 Jul;96(28):e7183. doi: 10.1097/MD.0000000000007183.
Thoracic endovascular aortic repair (TEVAR) in the current era has been chosen as a dominant and minimally invasive treatment for complicated aorta dissection. This study aimed to assess safety and feasibility of TEVAR in acute and chronic type B aortic dissection.Between January 2011 and December 2013, 85 patients with complicated type B aortic dissection undergoing TEVAR were divided into acute aortic dissection (AAD) (n = 60) group and chronic aortic dissection (CAD) group (n = 25). Computed tomography was used to evaluate postoperative changes in maximal aortic diameter and true and false lumen diameters at 3 levels during a mean follow-up period of 26.4 ± 15.6 months.The technical success rate was 100%. In-hospital and 30-day rates of death were 3.3% in acute group and 0 in chronic group. Postdischarge rates of type I leak, type II leak, and retrograde type A dissection were 6.7%, 5.2%, and 3.4% (acute) and 0%, 4.0%, and 4.0% (chronic), respectively. The maximal aorta diameter remained stable in all the 3 levels in both acute and chronic group. The cumulative freedom from all-cause mortality at 3 years was similar in acute and chronic groups (89.5% vs 95.5%, P = .308). The cumulative freedom from aortic-related mortality was also not significantly different in the acute and chronic groups (92.8% vs 95.2%, P = .531). In the thoracic aorta, TEVAR treatment resulted in a significant increase in true lumen (TL) diameter and decrease in false lumen (FL). However, in the abdominal aorta, TEVAR did not lead to significant change in TL and FL diameters. The rates of complete thrombosis thoracic false lumens were better than that in the abdominal false lumen.TEVAR was a safe and effect therapy for complicated acute and chronic type B dissection with low early and mid-term mortality and morbidity.
在当今时代，胸主动脉腔内修复术（TEVAR）已被选为复杂主动脉夹层的主要微创治疗方法。本研究旨在评估TEVAR治疗急性和慢性B型主动脉夹层的安全性和可行性。2011年1月至2013年12月期间，85例行TEVAR治疗的复杂B型主动脉夹层患者被分为急性主动脉夹层（AAD）组（n = 60）和慢性主动脉夹层（CAD）组（n = 25）。在平均26.4±15.6个月的随访期内，采用计算机断层扫描评估术后3个层面的主动脉最大直径以及真腔和假腔直径的变化。技术成功率为100%。急性组的住院死亡率和30天死亡率分别为3.3%，慢性组为0。出院后I型内漏、II型内漏和逆行A型夹层的发生率分别为6.7%、5.2%和3.4%（急性）以及0%、4.0%和4.0%（慢性）。急性组和慢性组在所有3个层面的主动脉最大直径均保持稳定。急性组和慢性组3年全因死亡率的累积自由度相似（89.5%对95.5%，P = 0.308）。急性组和慢性组主动脉相关死亡率的累积自由度也无显著差异（92.8%对95.2%，P = 0.531）。在胸主动脉，TEVAR治疗使真腔（TL）直径显著增加，假腔（FL）直径减小。然而，在腹主动脉，TEVAR并未导致TL和FL直径发生显著变化。胸段假腔完全血栓形成率优于腹段假腔。TEVAR是治疗复杂急性和慢性B型夹层的一种安全有效的疗法，早期和中期死亡率及发病率较低。
