Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Florida.
Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Florida.
Ann Thorac Surg. 2021 May;111(5):1560-1569. doi: 10.1016/j.athoracsur.2020.07.017. Epub 2020 Sep 20.
The efficacy of thoracic endovascular aortic repair (TEVAR) of chronic type B aortic dissection (cTBAD) is controversial. Only limited evidence describes temporal anatomic changes after TEVAR for cTBAD and their relationship to outcomes. We sought to investigate early aortic remodeling events after TEVAR for cTBAD with thoracic aneurysm and determine the association with reintervention and survival.
Records from 95 cTBAD patients undergoing TEVAR from 2005 to 2017 were reviewed. Using 3-dimensional centerline analysis, anatomic phenotyping of the thoracoabdominal aorta was performed. Reverse aortic remodeling (RAR) was defined by a ≥5-mm reduction in maximal thoracic aortic diameter. Kaplan-Meier analysis estimated freedom from reintervention and survival.
Visceral segment dissection involvement was present in 89% of patients (n = 85), and the mean preoperative thoracic diameter was 63 mm (SD, 10). Complete thoracic false lumen thrombosis occurred in 71% of patients (n = 67), whereas abdominal false lumen thrombosis was documented in 60% (n = 57) by 6 months. RAR occurred in 41%. Aortic reintervention rate was 39% (n = 37). The 1- and 3-year freedom from reintervention was significantly higher in subjects experiencing early RAR (log-rank P = .02), but reintervention did not impact overall survival (log-rank P = .9). Similarly, overall survival was similar between patients with or without RAR (log-rank P = .4).
Early RAR is associated with decreased rates of reintervention; however, overall survival is not impacted by these changes. TEVAR for cTBAD results in a high rate of reintervention, which mandates vigilant surveillance protocols.
胸主动脉腔内修复术（TEVAR）治疗慢性 B 型主动脉夹层（cTBAD）的疗效存在争议。仅有有限的证据描述了 cTBAD 患者接受 TEVAR 治疗后的时间解剖学变化及其与结局的关系。我们试图研究 cTBAD 合并胸主动脉瘤患者接受 TEVAR 治疗后的早期主动脉重塑事件，并确定其与再介入和生存的关系。
回顾了 2005 年至 2017 年期间接受 TEVAR 治疗的 95 例 cTBAD 患者的记录。使用三维中心线分析，对胸腹主动脉进行解剖表型分析。反向主动脉重塑（RAR）定义为最大胸主动脉直径减少≥5mm。Kaplan-Meier 分析估计无再介入和生存的自由。
89%（85 例）患者存在内脏段夹层受累，术前胸主动脉直径平均为 63mm（标准差，10mm）。71%（67 例）患者完全血栓形成胸主动脉假腔，6 个月时记录到 60%（57 例）患者腹主动脉假腔血栓形成。RAR 发生率为 41%。主动脉再介入率为 39%（37 例）。在早期 RAR 的患者中，1 年和 3 年无再介入的自由率显著更高（对数秩 P=.02），但再介入并不影响总生存（对数秩 P=.9）。同样，有或没有 RAR 的患者的总生存率相似（对数秩 P=.4）。
早期 RAR 与再介入率降低相关；然而，这些变化并不影响总生存。cTBAD 患者接受 TEVAR 治疗后，再介入率较高，需要进行严格的监测方案。
