Ye Kaichuang, Qin Jinbao, Yin Minyi, Jiang Mi'er, Li Weimin, Lu Xinwu
Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, and Vascular Center of Shanghai JiaoTong University, 639 Zhizaoju Road, Shanghai 200011, China.
Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, and Vascular Center of Shanghai JiaoTong University, 639 Zhizaoju Road, Shanghai 200011, China.
J Vasc Interv Radiol. 2017 Oct;28(10):1446-1453.e2. doi: 10.1016/j.jvir.2017.06.034. Epub 2017 Aug 18.
To compare midterm outcomes of optimal medical treatment (OMT) alone with OMT and thoracic endovascular aortic repair (TEVAR) of acute type B intramural hematoma (IMHB).
Retrospective analysis was performed of 65 patients treated with OMT alone (31 patients) or OMT with TEVAR (34 patients) for acute uncomplicated or complicated IMHB from January 2006 to December 2015 in a single institution. Primary outcome was aortic-related mortality during follow-up. Secondary outcomes were aortic-related adverse events, all-cause mortality, and occurrence of complete aortic remodeling.
Except for the morphologic nature of the aortic lesion, no significant differences in baseline characteristics between the 2 groups were observed. Mean follow-up time was 32 months ± 19 (range, 1-120 months). Patients in the OMT group had a significantly increased rate of aortic-related mortality (12.9% vs 0% in TEVAR group, P = .046) and aortic-related adverse events (29.0% vs 0% in TEVAR group, P < .001) and an insignificant but higher trending all-cause mortality rate (38.8% vs 19.8% in TEVAR group, P = .15). The occurrence of complete aortic remodeling was significantly lower in the OMT group (15.4% vs 82.1% in TEVAR group, P < .001).
TEVAR is likely to protect from progression of IMHB and to be associated with a better prognosis than OMT alone.
比较单纯最佳药物治疗（OMT）与OMT联合胸段血管腔内主动脉修复术（TEVAR）治疗急性B型壁内血肿（IMHB）的中期疗效。
对2006年1月至2015年12月在单一机构接受单纯OMT（31例患者）或OMT联合TEVAR（34例患者）治疗急性非复杂性或复杂性IMHB的65例患者进行回顾性分析。主要结局是随访期间与主动脉相关的死亡率。次要结局是与主动脉相关的不良事件、全因死亡率以及完全主动脉重塑的发生情况。
除主动脉病变的形态学特征外，两组之间的基线特征未观察到显著差异。平均随访时间为32个月±19（范围1 - 120个月）。OMT组患者与主动脉相关的死亡率显著增加（12.9% vs TEVAR组0%，P = .046）以及与主动脉相关的不良事件（29.0% vs TEVAR组0%，P < .001），全因死亡率虽无显著差异但有更高的趋势（38.8% vs TEVAR组19.8%，P = .15）。OMT组完全主动脉重塑的发生率显著更低（15.4% vs TEVAR组82.1%，P < .001）。
TEVAR可能预防IMHB进展，且与比单纯OMT更好的预后相关。
