Piffaretti Gabriele, Lomazzi Chiara, Benedetto Filippo, Pipitò Narayana, Castelli Patrizio, Trimarchi Santi, Dorigo Walter, Tozzi Matteo
Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy.
Vascular Surgery II and Thoracic Aortic Research Center, IRCCS Policlinico San Donato Teaching Hospital, University of Milan School of Medicine, Milan, Italy.
Semin Thorac Cardiovasc Surg. 2018;30(3):279-287. doi: 10.1053/j.semtcvs.2018.02.006. Epub 2018 Feb 9.
This study aimed to describe our experience with the management and the results of stent-graft (SG) repair of acute type B aortic intramural hematoma (B-IMH). Between January 2005 and July 2016, we identified 41 B-IMHs. Major end points were early and long-term survival, aortic remodeling, freedom from aortic-related mortality (ARM), and freedom from reintervention. Thirty-one (76%) patients eventually underwent SG repair: 16 (52%) cases in the acute phase, and 6 (19%) in the subacute (14-30 days) phase. Nine (29%) patients showed aortic lesion progression in the follow-up despite best medical treatment, and required SG repair in the chronic phase. The presence of ulcer-like projections at the admission computed tomography angiography was significantly higher in patients who eventually required SG repair (5% vs 36%, odds ratio: 4.08, P = .043). At 12 months, whereas ARM showed a trend in favor of SG (84% ± 10 vs 100%; log-rank: P = .075), the freedom from aortic progression was significantly lower in the SG group (64% ± 13 vs 94% ± 5; log-rank: P = .002). Median follow-up was 31 months (range, 2-96; interquartile range, 11-62.5). Freedom from ARM and freedom from aortic reintervention was 92% ± 5 (95% confidence interval: 75-98) at 12 months. Aortic remodeling was observed in 26 (84%) patients. No differences were noted between patients treated with SG in the acute and in the chronic phase. In our experience, B-IMH was associated with 47% aortic adverse event rate in the follow-up with best medical treatment alone. At mid-term, results of SG repair are encouraging.
本研究旨在描述我们对急性B型主动脉壁内血肿（B-IMH）进行支架型人工血管（SG）修复的管理经验及结果。2005年1月至2016年7月期间，我们共识别出41例B-IMH。主要终点为早期和长期生存率、主动脉重塑、无主动脉相关死亡率（ARM）以及无需再次干预。31例（76%）患者最终接受了SG修复：急性期16例（52%），亚急性期（14 - 30天）6例（19%）。9例（29%）患者尽管接受了最佳药物治疗，但在随访中仍出现主动脉病变进展，需在慢性期进行SG修复。最终需要SG修复的患者在入院计算机断层扫描血管造影时出现溃疡样突出的比例显著更高（5% 对36%，优势比：4.08，P = 0.043）。在12个月时，虽然ARM显示出SG治疗更有优势的趋势（84% ± 10对100%；对数秩检验：P = 0.075），但SG组的无主动脉进展率显著更低（64% ± 13对94% ± 5；对数秩检验：P = 0.002）。中位随访时间为31个月（范围2 - 96个月；四分位间距11 - 62.5个月）。12个月时的无ARM率和无主动脉再次干预率为92% ± 5（95%置信区间：75 - 98）。26例（84%）患者观察到主动脉重塑。急性期和慢性期接受SG治疗的患者之间未发现差异。根据我们的经验，仅采用最佳药物治疗进行随访时，B-IMH的主动脉不良事件发生率为47%。中期时，SG修复的结果令人鼓舞。
