Tang Jun Han, Lo Zhiwen Joseph, Wong Jiayi, Hong Qiantai, Yong Enming, Chandrasekar Sadhana, Tan Glenn Wei Leong
Division of Vascular and Endovascular Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
Division of Vascular and Endovascular Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
Ann Vasc Surg. 2020 Nov;69:352-359. doi: 10.1016/j.avsg.2020.05.058. Epub 2020 Jun 2.
Management of uncomplicated type B aortic dissection (TBAD) has traditionally been aggressive medical therapy. Recent studies brought about a paradigm shift with evidence to suggest benefits from early endovascular intervention to a high risk subgroup of acute uncomplicated TBAD patients.
We aim to review the effects of aortic remodeling in Asian patients with TBAD with and without endovascular intervention, including maximal aortic diameter, true lumen diameter, and false lumen thrombosis.
This is a single-center retrospective study of a prospective database. Patients who presented to our institution with acute TBAD from January 2008 to December 2015 (n = 44) were evaluated. Eighteen percent (8 patients) presented with complicated TBAD and underwent emergency thoracic endovascular aortic repair (TEVAR) while the remaining 82% (36 patients) were treated with optimal medical therapy (OMT).
Six patients under the conservative arm crossed over to elective TEVAR after 6 weeks because of interval radiological progression of disease. There was no significant difference in the baseline demographics of the TEVAR group and the OMT group. At 24 months, mean maximal aortic diameter difference was -7.7 mm and +1.9 mm (P = 0.077), mean true lumen diameter difference was +10.0 mm and +2.6 mm (P = 0.049), and false lumen thrombosis was 100% and 20% (P = 0.012) for TEVAR and OMT, respectively. Kaplan-Meier analysis showed no significant difference in mortality between the 2 groups at 30 days and 2 years.
Within an Asian population with TBAD, TEVAR with OMT has a significant positive effect on aortic remodeling, compared with OMT-only management.
传统上，单纯性B型主动脉夹层（TBAD）的治疗方法是积极的药物治疗。最近的研究带来了范式转变，有证据表明早期血管内介入治疗对急性单纯性TBAD患者的高危亚组有益。
我们旨在回顾血管内介入治疗与未介入治疗的亚洲TBAD患者的主动脉重塑效果，包括最大主动脉直径、真腔直径和假腔血栓形成情况。
这是一项基于前瞻性数据库的单中心回顾性研究。对2008年1月至2015年12月期间在我院就诊的急性TBAD患者（n = 44）进行了评估。18%（8例患者）表现为复杂性TBAD并接受了急诊胸主动脉腔内修复术（TEVAR），其余82%（36例患者）接受了最佳药物治疗（OMT）。
保守治疗组中有6例患者在6周后因疾病的影像学进展而转为选择性TEVAR。TEVAR组和OMT组的基线人口统计学特征无显著差异。在24个月时，TEVAR组和OMT组的平均最大主动脉直径差异分别为-7.7 mm和+1.9 mm（P = 0.077），平均真腔直径差异分别为+10.0 mm和+2.6 mm（P = 0.049），假腔血栓形成率分别为100%和20%（P = 0.012）。Kaplan-Meier分析显示，两组在30天和2年时的死亡率无显著差异。
在亚洲TBAD患者中，与单纯OMT治疗相比，TEVAR联合OMT对主动脉重塑有显著的积极影响。
