Department of Surgery; National Taiwan University Hospital, Taipei, Taiwan; Department of Cardiovascular Surgery, Ageo Central General Hospital, Saitama, Japan.
Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Eur J Vasc Endovasc Surg. 2020 Sep;60(3):386-393. doi: 10.1016/j.ejvs.2020.05.021. Epub 2020 Jul 30.
The current treatment for acute retrograde type A intramural haematoma (IMH) remains challenging. Aortic remodelling in both the ascending aorta (AA) and descending thoracic aorta (DTA) was evaluated and the 30 day and mid term outcomes were determined in patients who underwent thoracic endovascular aneurysm repair (TEVAR) for retrograde type A IMH with a primary intimal tear or ulcer like projection in the DTA METHODS: This was a retrospective, multicentre observational study. Clinical data, including post-operative mortality and adverse event, aorta related re-intervention, aortic remodelling, and the survival rate of 18 non-consecutive patients with acute retrograde type A IMH undergoing TEVAR between June 2006 and March 2018 were reviewed.
The median age at repair was 58.1 years (range 38-86) and 14 (78%) were men. Eight patients (44%) presented with haemopericardium, and 10 (56%) underwent TEVAR within 24 h. The mean IMH thickness and AA diameter were 10.4 ± 3.6 and 45.7 ± 4.6 mm, respectively. Among all patients with acute retrograde type A IMH, 11 patients presented with classical type B aortic dissection and seven with type B IMH. All procedures were technically successful. The median follow up was 28.7 months (range 7-78). No 30 day mortality was observed. Three patients developed post-procedure adverse events. Of these, two patients had neurological events, with one each having cerebrovascular and spinal cord infarction individually, and the third patient required long term haemodialysis with ventilator support. The overall survival rate was 100%. The maximum diameter of the AA and the IMH in the AA significantly decreased after TEVAR. Aortic remodelling was also observed in the DTA along the length of TEVAR coverage.
In selected patients with acute retrograde type A IMH, TEVAR offered a treatment alternative to open surgical grafting and medical follow up.
急性逆行性 A 型主动脉壁内血肿（IMH）的当前治疗仍然具有挑战性。本研究评估了升主动脉（AA）和降主动脉（DTA）的主动脉重塑，并确定了在 DTA 中存在原发性内膜撕裂或溃疡样突起的逆行性 A 型 IMH 患者接受胸主动脉腔内修复术（TEVAR）后的 30 天和中期结果。
这是一项回顾性、多中心观察性研究。回顾了 2006 年 6 月至 2018 年 3 月期间接受 TEVAR 治疗的 18 例非连续急性逆行性 A 型 IMH 患者的临床资料，包括术后死亡率和不良事件、与主动脉相关的再次干预、主动脉重塑以及患者的生存率。
修复时的中位年龄为 58.1 岁（范围 38-86 岁），14 例（78%）为男性。8 例（44%）患者出现血心包，10 例（56%）患者在 24 小时内行 TEVAR 治疗。急性逆行性 A 型 IMH 患者的平均 IMH 厚度和 AA 直径分别为 10.4±3.6mm 和 45.7±4.6mm。所有患者中，11 例为经典型 B 型主动脉夹层，7 例为 B 型 IMH。所有手术均成功完成。中位随访时间为 28.7 个月（范围 7-78 个月）。无 30 天死亡率。3 例患者发生术后不良事件。其中 2 例出现神经事件，分别为脑血管和脊髓梗死各 1 例，第 3 例需要长期血液透析和呼吸机支持。总的生存率为 100%。TEVAR 后 AA 的最大直径和 AA 中的 IMH 明显减小。TEVAR 覆盖范围内的 DTA 也观察到了主动脉重塑。
在选择的急性逆行性 A 型 IMH 患者中，TEVAR 为开放手术和内科随访提供了一种治疗选择。
