Zhou Yi, Wang Wei-Cheng, Zhang Xiao-Ming, Yang Cui, Zheng Jing, Yang Lin, Dong Ling, Hu Xiao, Zhu Tao, Wang Ya-Li, Yang Yan
Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China.
Department of Preventive Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China.
Quant Imaging Med Surg. 2018 May;8(4):391-398. doi: 10.21037/qims.2018.05.03.
Thoracic endovascular aortic repair (TEVAR) in the current era has gained widespread acceptance as the modality of choice for the treatment of complicated aortic dissection (AD). However, reports on clinical results of TEVAR treatment of AD patients are mainly comparisons and analyses of results between patients in the acute and chronic phases, few reports have described the postoperative aortic remodelling of patients with subacute AD after TEVAR. The aim of this study was to investigate aortic remodelling after TEVAR in acute and subacute Stanford type B AD patients.
The clinical data of 38 Stanford type B AD patients who received TEVAR treatment in our hospital between July 2012 and December 2017 were retrospectively analysed. The maximum diameters of the aorta, the mean diameters of the true lumens (TLs) and the false lumens (FLs) of the aorta in the dissection range before and after TEVAR treatment were measured. All diameters between different groups or in the same group before and after therapy were compared using nonparametric tests. Count data were examined using the χ test.
The 38 patients were 31.0-82.0 years old with a mean age of 57.0±11.0 years, including 31 men and 7 women, with 22 patients in the acute phase and 16 patients in the subacute phase. Among the 38 patients included in this study, 7 (18.4%) patients had endoleaks after treatment. No perioperative deaths occurred. Analyses of computed tomography angiography measurement results showed that the baseline maximum diameters of the aorta, TLs and FLs before TEVAR between the acute and subacute groups were not significantly different (P=0.193, P=0.301 and P=0.067, respectively). After TEVAR treatment, the maximum diameters of the aorta and the diameters of the FLs were different between the two groups (P=0.005 and P=0.012), but the diameters of the TLs were not (P=0.069). The diameters of the TLs increased, and those of FLs decreased significantly in the acute and subacute groups after TEVAR (P<0.001, P<0.001, P<0.001 and P=0.007, respectively); the maximum diameters of the aorta decreased significantly in the acute group (P<0.001), but they did not change obviously in the subacute group (P=0.121).
TEVAR offers satisfactory results for the treatment of type B AD. Acute AD may be associated with better aortic remodelling compared to subacute AD after TEVAR.
在当今时代，胸主动脉腔内修复术（TEVAR）已被广泛认可为治疗复杂性主动脉夹层（AD）的首选方式。然而，关于TEVAR治疗AD患者临床结果的报道主要是急性期和慢性期患者结果的比较与分析，很少有报道描述亚急性AD患者TEVAR术后的主动脉重塑情况。本研究的目的是调查急性和亚急性斯坦福B型AD患者TEVAR术后的主动脉重塑情况。
回顾性分析2012年7月至2017年12月在我院接受TEVAR治疗的38例斯坦福B型AD患者的临床资料。测量TEVAR治疗前后夹层范围内主动脉的最大直径、真腔（TL）和假腔（FL）的平均直径。不同组之间或同一组治疗前后的所有直径采用非参数检验进行比较。计数资料采用χ检验。
38例患者年龄31.0 - 82.0岁，平均年龄57.0±11.0岁，其中男性31例，女性7例，急性期22例，亚急性期16例。本研究纳入的38例患者中，7例（18.4%）治疗后发生内漏。无围手术期死亡病例。计算机断层扫描血管造影测量结果分析显示，急性组和亚急性组TEVAR术前主动脉、TL和FL的基线最大直径差异无统计学意义（分别为P = 0.193、P = 0.301和P = 0.067）。TEVAR治疗后，两组主动脉最大直径和FL直径不同（P = 0.005和P = 0.012），但TL直径无差异（P = 0.069）。TEVAR术后急性组和亚急性组TL直径增加，FL直径显著减小（分别为P < 0.001、P < 0.001、P < 0.001和P = 0.007）；急性组主动脉最大直径显著减小（P < 0.001），亚急性组变化不明显（P = 0.121）。
TEVAR治疗B型AD效果满意。与TEVAR术后亚急性AD相比，急性AD可能与更好的主动脉重塑相关。
