Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
Department of Cardiovascular Surgery, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
Jpn J Radiol. 2019 Apr;37(4):321-327. doi: 10.1007/s11604-019-00813-7. Epub 2019 Feb 2.
To evaluate the efficacy of thoracic endovascular aortic repair (TEVAR) for ruptured acute type B aortic dissection (r-ATBAD).
The study included 18 patients (15 men and 3 women) who underwent TEVAR for r-ATBAD in two institutions between 1997 and 2017. The mean patient age was 74 ± 10 years. The false lumen was patent in 13 patients (72%) and was mostly thrombosed in 5 patients (28%). Three patients had malperfusion of aortic branches. Eight patients (44%) were in circulatory shock.
Eleven patients (61%) died during or following TEVAR during admission. The causes of death were aortic rupture (n = 6), sepsis (n = 2), cerebral hypoxia (n = 1), pneumonia (n = 1), and renal failure (n = 1). Statistical analysis showed that dissection extending to the infrarenal level was significantly related to death from aortic rupture (P = 0.013). Early adverse events were observed in 12 patients (67%). One patient died from a non-aorta-related cause (sepsis) after discharge. The overall survival rate at 1 year was 39%. After discharge, an aorta-related adverse event (intimal injury) was observed in one patient. The adverse event-free survival rate at 1 year was 17%.
Our results indicate that TEVAR for r-ATBAD is associated with high mortality and morbidity. More advanced strategies may be required to improve the outcome.
评估胸主动脉腔内修复术（TEVAR）治疗急性破裂型 B 型主动脉夹层（r-ATBAD）的疗效。
本研究纳入了 1997 年至 2017 年间在两个机构接受 TEVAR 治疗的 18 例 r-ATBAD 患者（15 名男性，3 名女性）。患者平均年龄为 74±10 岁。13 例患者（72%）假腔通畅，5 例患者（28%）假腔大部分血栓形成。3 例患者主动脉分支血运不良。8 例患者（44%）处于循环休克状态。
11 例患者（61%）在 TEVAR 期间或之后住院期间死亡。死亡原因包括主动脉破裂（n=6）、脓毒症（n=2）、脑缺氧（n=1）、肺炎（n=1）和肾衰竭（n=1）。统计分析显示，夹层延伸至肾下水平与主动脉破裂导致的死亡显著相关（P=0.013）。12 例患者（67%）出现早期不良事件。1 例患者出院后死于非主动脉相关原因（脓毒症）。1 年总体生存率为 39%。出院后，1 例患者出现主动脉相关不良事件（内膜损伤）。1 年无不良事件生存率为 17%。
我们的研究结果表明，TEVAR 治疗 r-ATBAD 死亡率和发病率较高。可能需要更先进的策略来改善预后。
