Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany.
Department of Cardiology, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany.
Eur J Cardiothorac Surg. 2017 Sep 1;52(3):508-515. doi: 10.1093/ejcts/ezx236.
In DeBakey Type I acute aortic dissection, the frozen elephant trunk technique is used for the combined treatment of both the proximal and distal thoracic aorta. Anatomical characteristics of the distal aorta and their impact on false lumen (FL) thrombosis and aortic remodelling were analysed in this study.
Sufficient pre-, postoperative, and at least one 1-year follow-up computed tomography data sets were available for 63 of 94 patients treated with the frozen elephant trunk for Type I acute aortic dissection between March 2005 and March 2015. Aortic remodelling and FL thrombosis quotients were calculated volumetrically at the stent graft level (A), from A to the coeliac trunk (B) and from B to the bifurcation (C) and were correlated with the number and size of entry tears and aortic branches arising from the FL (exits) in each segment.
Positive or stable remodelling was found in Segments A (94%), B (64%) and C (54%), and the FL thrombosis quotient was 98% in A, 68% in B and 39% in C within the first year. FL thrombosis correlated negatively with the total size of the entry (P<0.001) and the number of exits (P<0.001) and positively with the number of true-lumen branches (P<0.001). The exit number was a risk factor for FL patency and a predictor of negative remodelling.
Using frozen elephant trunk technique to treat Type I acute aortic dissection facilitates positive or stable remodelling in nearly all patients at the stent graft level and distally in two-thirds of the patients. FL thrombosis and aortic remodelling are negatively influenced by the number of exits. New endovascular concepts aiming at reducing the number of exits may prevent negative remodelling.
在 DeBakey I 型急性主动脉夹层中，使用冷冻象鼻技术联合治疗近端和远端胸主动脉。本研究分析了远端主动脉的解剖学特征及其对假腔（FL）血栓形成和主动脉重塑的影响。
2005 年 3 月至 2015 年 3 月，对 94 例采用冷冻象鼻治疗 I 型急性主动脉夹层的患者中的 63 例进行了充分的术前、术后及至少 1 年的随访，获得了 CT 数据集。在支架移植物水平（A）、从 A 到腹腔干（B）和从 B 到分叉（C）处，计算了主动脉重塑和 FL 血栓形成比率，并与每个节段的入口撕裂数量和大小以及源自 FL 的主动脉分支（出口）相关联。
A（94%）、B（64%）和 C（54%）段均表现为正性或稳定重塑，A 段的 FL 血栓形成比率在第 1 年内为 98%，B 段为 68%，C 段为 39%。FL 血栓形成与入口撕裂的总大小（P<0.001）和出口数量（P<0.001）呈负相关，与真腔分支数量（P<0.001）呈正相关。出口数量是 FL 通畅的危险因素，也是负性重塑的预测因子。
采用冷冻象鼻技术治疗 I 型急性主动脉夹层，在支架移植物水平和三分之二的患者中，在远端，几乎所有患者均表现为正性或稳定重塑。FL 血栓形成和主动脉重塑受出口数量的影响。旨在减少出口数量的新的血管内概念可能预防负性重塑。
