The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China; Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China.
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China.
J Vasc Surg. 2023 Apr;77(4):1028-1036.e2. doi: 10.1016/j.jvs.2022.10.036. Epub 2022 Nov 1.
To report the results of optimal medical treatment (OMT) and endovascular aortic repair (EVAR) in patients with uncomplicated isolated abdominal aortic dissection (IAAD).
A retrospective review of 96 consecutive patients with uncomplicated IAAD (uIAAD) managed at a single tertiary vascular unit between January 2011 and July 2021 was conducted. Standard methods for univariate and survival analyses were used. The primary outcomes were all-cause mortality. Secondary end points included uIAAD progression, interventional complications, and follow-up aortic intervention.
Initially, 53.1% of patients (51/96) were managed with OMT. No in-hospital deaths occurred. During follow-up, three patients died, and three and two patients who were initially managed with OMT subsequently required endovascular treatment and surgical management, respectively. Initially, 46.9% of patients (45/96) underwent EVAR. One patient died during hospital admission; nine patients had an endoleak after operation and one needed reintervention. Furthermore, during follow-up, five patients died; four patients needed reoperation, one surgery and three endovascular treatments. The overall long-term mortality was 8.4%, and follow-up aortic intervention rate was 9.5% (median follow-up, 54 months; interquartile range, 33-81 months) with no significant difference between groups. Of note, 12 patients (12.6%) suffered uIAAD progression, which was higher in the OMT group than EVAR group (10 [19.6%] vs 2 [4.5%]; P = .03).
uIAAD may be managed safely by OMT with regular surveillance, despite the risk of disease progression. Compared with OMT, EVAR could significantly prevent uIAAD progression. For anatomically suitable patients with uIAAD progression and who are unresponsive to OMT, pre-emptive EVAR is a safe and feasible option.
报告单纯性孤立性腹主动脉夹层（IAAD）患者接受最佳药物治疗（OMT）和血管内主动脉修复（EVAR）的结果。
回顾性分析了 2011 年 1 月至 2021 年 7 月在单一三级血管单位接受治疗的 96 例单纯性 IAAD（uIAAD）连续患者。采用单变量和生存分析的标准方法。主要结局是全因死亡率。次要终点包括 uIAAD 进展、介入并发症和随访主动脉介入。
最初，53.1%的患者（51/96）接受 OMT 治疗。住院期间无死亡。在随访期间，有 3 例死亡，3 例最初接受 OMT 治疗的患者随后分别需要血管内治疗和手术治疗，2 例最初接受 OMT 治疗的患者随后分别需要血管内治疗和手术治疗。最初，46.9%的患者（45/96）接受 EVAR 治疗。1 例患者在住院期间死亡；9 例患者手术后存在内漏，1 例需要再次介入治疗。此外，在随访期间，有 5 例死亡；4 例需要再次手术，1 例手术，3 例血管内治疗。总的长期死亡率为 8.4%，随访主动脉介入率为 9.5%（中位随访时间为 54 个月；四分位距为 33-81 个月），两组间无显著差异。值得注意的是，有 12 例（12.6%）患者发生 uIAAD 进展，OMT 组高于 EVAR 组（10[19.6%]比 2[4.5%]；P=.03）。
尽管存在疾病进展的风险，但通过定期监测，uIAAD 可通过 OMT 安全治疗。与 OMT 相比，EVAR 可显著预防 uIAAD 进展。对于解剖上适合且对 OMT 无反应的 uIAAD 进展患者，预防性 EVAR 是一种安全可行的选择。
