Department of Vascular Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China.
Department of Pathology, the Affiliated Hospital of Qingdao University, Qingdao, China.
Ann Vasc Surg. 2022 Oct;86:380-388. doi: 10.1016/j.avsg.2022.05.004. Epub 2022 May 18.
This study evaluated aortic remodeling in highly tapered type B aortic dissection (TBAD) patients who underwent thoracic endovascular aortic repair (TEVAR) with a proximal tapered stent graft plus a distal restrictive stent graft to maximize thoracic coverage while avoiding distal excessive oversizing.
Thirty-four patients presenting with highly tapered TABD were randomized to restricted TEVAR (r-TEVAR) and standard TEVAR groups. Highly tapered TBAD was defined as the maximal diameter of the true lumen at proximal and distal thoracic aorta landing zone tapers greater than 8 mm or taper ratio greater than 20%. Patients in the r-TEVAR group underwent proximal tapered stent grafts plus distal restrictive stent grafts, to match the taper ratio of the descending thoracic aorta (DTA) and extend the length of stent coverage. Patients in the standard TEVAR group underwent proximal tapered stent grafts implantation without distal restrictive stent grafts. Aortic remodeling was estimated by computed tomography angiography (CTA) during the follow-up.
In total, 16 patients underwent r-TEVAR, and 18 patients underwent standard TEVAR. The taper ratio of the stent graft matched the DTA in the r-TEVAR group (24.7 ± 3.4% vs. 27.3 ± 4.2%, P = 0.068), but did not match that in the standard TEVAR group (13.5 ± 3.3% vs. 30.5 ± 9.6%, P < 0.001). The length of stent graft coverage in the r-TEVAR group was longer than that in the standard TEVAR group (220.4 ± 21.1 mm vs. 175.3 ± 17.8 mm, P < 0.001). Compared with the standard TEVAR group, the r-TEVAR group had better complete remodeling of the DTA at 6 months (40% vs. 5.6%, P = 0.03), 12 months (60% vs. 16.7%, P = 0.027), and 24 months (78.6% vs. 41.2%, P = 0.036) after the operation. There was no difference in the cumulative survival rate between the r-TEVAR and standard TEVAR groups (P = 0.166).
The r-TEVAR with overlapping proximal tapered stent grafts and distal restrictive stent grafts can match the taper of highly tapered TABD, extend the length of stent graft coverage, and lead to better remodeling of the DTA than standard TEVAR.
本研究评估了在接受近端锥形支架移植物加远端限制性支架移植物的经胸主动脉腔内修复术（TEVAR）治疗的高度锥形 B 型主动脉夹层（TBAD）患者中的主动脉重塑情况，以最大限度地增加胸主动脉覆盖范围，同时避免远端过度扩张。
34 例高度锥形 TBAD 患者被随机分为限制性 TEVAR（r-TEVAR）组和标准 TEVAR 组。高度锥形 TBAD 的定义为近端和远端胸主动脉着陆区的真腔最大直径锥形大于 8mm 或锥形比大于 20%。r-TEVAR 组的患者接受近端锥形支架移植物加远端限制性支架移植物，以匹配降主动脉（DTA）的锥形比并延长支架覆盖的长度。标准 TEVAR 组的患者接受近端锥形支架移植物植入，而不接受远端限制性支架移植物。通过随访期间的 CT 血管造影（CTA）评估主动脉重塑。
共有 16 例患者接受 r-TEVAR，18 例患者接受标准 TEVAR。r-TEVAR 组的支架移植物锥形比与 DTA 相匹配（24.7±3.4%比 27.3±4.2%，P=0.068），但与标准 TEVAR 组不匹配（13.5±3.3%比 30.5±9.6%，P<0.001）。r-TEVAR 组的支架移植物覆盖长度长于标准 TEVAR 组（220.4±21.1mm 比 175.3±17.8mm，P<0.001）。与标准 TEVAR 组相比，r-TEVAR 组在术后 6 个月（40%比 5.6%，P=0.03）、12 个月（60%比 16.7%，P=0.027）和 24 个月（78.6%比 41.2%，P=0.036）时 DTA 的完全重塑更好。r-TEVAR 组和标准 TEVAR 组的累积生存率无差异（P=0.166）。
重叠的近端锥形支架移植物和远端限制性支架移植物的 r-TEVAR 可以匹配高度锥形 TBAD 的锥形，延长支架移植物覆盖的长度，并导致 DTA 的重塑优于标准 TEVAR。
