Verma Mansi, Ojha Vineeta, Deshpande Amit Ajit, Pratap Singh Surya, Ramakrishnan Pradeep, Kumar Sanjeev
Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029 India.
Department of Cardiovascular Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, India.
Indian J Thorac Cardiovasc Surg. 2022 Jul;38(4):375-381. doi: 10.1007/s12055-022-01369-4. Epub 2022 May 11.
To examine the association between aortic coverage and occurrence of spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection.
Thirty-eight consecutive patients (mean age 52 years; 35 men) who underwent TEVAR for type B aortic dissection at our centre were included. Patients were stratified into two groups based on stent graft length (SGL): group I (≤ 200 mm; = 19) and group II (> 200 mm; = 19). All the procedures were performed under strict blood pressure monitoring. Preoperative cerebrospinal fluid (CSF) drain was instituted in two patients.
Mean SGLs were 200 mm in group I and 277 ± 27 mm in group II. The number of segmental arteries covered was significantly different between the two groups ( < 0.001). There was no significant difference in vertebral artery dominance between groups I and II ( = 0.99). One patient in group II, who also had bilateral internal iliac artery occlusion, developed postprocedural neurological deficit referrable to SCI, which resolved completely after institution of CSF drainage. However, the incidence of SCI was not significantly different between group I and group II ( = 0.5).
Based on our experience, we recommend longer aortic coverage (beyond 200 mm) in type B aortic dissection (TBAD) for better aortic remodelling, provided that the mean arterial pressure of > 90 mm Hg is maintained perioperatively to avoid SCI.
探讨B型主动脉夹层腔内修复术（TEVAR）后主动脉覆盖范围与脊髓缺血（SCI）发生之间的关联。
纳入在本中心接受TEVAR治疗B型主动脉夹层的38例连续患者（平均年龄52岁；35例男性）。根据支架移植物长度（SGL）将患者分为两组：I组（≤200mm；n = 19）和II组（>200mm；n = 19）。所有手术均在严格的血压监测下进行。2例患者术前放置了脑脊液（CSF）引流管。
I组平均SGL为200mm，II组为277±27mm。两组间被覆盖的节段动脉数量有显著差异（P<0.001）。I组和II组之间椎动脉优势无显著差异（P = 0.99）。II组中有1例患者同时合并双侧髂内动脉闭塞，术后出现与SCI相关的神经功能缺损，在放置CSF引流管后完全缓解。然而，I组和II组之间SCI的发生率无显著差异（P = 0.5）。
根据我们的经验，对于B型主动脉夹层（TBAD），我们建议更长的主动脉覆盖范围（超过200mm）以实现更好的主动脉重塑，前提是围手术期维持平均动脉压>90mmHg以避免SCI。
