Bazylev V V, Shmatkov M G, Zakharov D A, Morozov Z A
Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Penza, Russia.
Angiol Sosud Khir. 2017;23(3):121-132.
The purpose of the study was to evaluate the influence of endoprosthetic repair of the aortic thoracic portion on remodelling of the descending aorta in patients after the surgical stage of correction for DeBakey type I aortic dissection.
The authors retrospectively analysed a group of 12 patients (9 men and 3 women) subjected to endoprosthetic repair of the aortic thoracic portion after previously performed surgical correction of the ascending aorta and its braches. The average age of the patients amounted to 48 (43-56.7) years. All patients underwent multispiral computed tomography (MSCT) first performed at admission, then immediately after implantation of the stent graft and at 6, 12 and 24 months after discharge. The Control Group consisted of nine patients with a previous history of DeBakey type I aortic dissection, who had endured only surgical correction of the ascending aorta and arch.
The success rate of the intervention amounted to 100%. There were no signs of ischaemia of the spinal cord, visceral organs or lower limbs. The diameter of the implanted stent grafts varied from 28 to 40 mm and the length ranged from 140 to 204 mm. Seven (58%) patients of the Study Group as early as during a year were found to have no blood flow along the false channel. The false channel remained patent in 100% of the Control Group patients. Over a two-year period of follow up, in patients after endoprosthetic repair, the diameter of the false channel did not increase. In the Control Group patients during the same period of follow up, there was a tendency towards an increase in the aortic diameter at the expense of dilatation of the false channel, with an enlargement of the false channel of the descending aorta at the level of the diaphragm from 1.8 (1.57-2.1) to 2.05 (1.7-2.31) cm (p=0.4) and at the level of the renal arteries from 1.5 (1.32-1.8) to 1.8 (1.58-1.97) cm (p=0.4). There were no lethal outcomes during follow up.
Endoprosthetic repair of the thoracic portion after surgical correction was in the remote period accompanied and followed by stabilization of the diameter of the descending aorta, as well as contributed to closure of the false channel.
本研究旨在评估I型主动脉夹层手术矫正术后患者，胸段主动脉腔内修复术对降主动脉重塑的影响。
作者回顾性分析了一组12例患者（9例男性，3例女性），这些患者在先前进行升主动脉及其分支的手术矫正后接受了胸段主动脉腔内修复术。患者的平均年龄为48（43 - 56.7）岁。所有患者均接受了多排螺旋计算机断层扫描（MSCT），入院时首次进行，然后在支架移植物植入后立即进行，出院后6个月、12个月和24个月各进行一次。对照组由9例曾患I型主动脉夹层的患者组成，他们仅接受了升主动脉和主动脉弓的手术矫正。
干预成功率达100%。无脊髓、内脏器官或下肢缺血迹象。植入的支架移植物直径从28毫米到40毫米不等，长度从140毫米到204毫米不等。研究组中有7例（58%）患者在一年内就发现假腔内无血流。对照组所有患者的假腔均保持通畅。在两年的随访期内，腔内修复术后患者的假腔直径未增加。在对照组患者的同一随访期内，主动脉直径有以假腔扩张为代价而增加的趋势，降主动脉在膈肌水平的假腔从1.8（1.57 - 2.1）厘米扩大到2.05（1.7 - 2.31）厘米（p = 0.4），在肾动脉水平从1.5（1.32 - 1.8）厘米扩大到1.8（1.58 - 1.97）厘米（p = 0.4）。随访期间无死亡病例。
手术矫正后的胸段主动脉腔内修复术在远期可使降主动脉直径稳定，并有助于闭合假腔。
