Department of Vascular Surgery, Institute of Vascular Surgery Zhongshan Hospital, Fudan University Shanghai China.
National Clinical Research Center for Interventional Medicine Shanghai China.
J Am Heart Assoc. 2023 Jan 3;12(1):e026914. doi: 10.1161/JAHA.122.026914. Epub 2022 Nov 16.
Background The treatment of chronic type B aortic dissection by thoracic endovascular aortic repair has some challenges, and its long-term outcomes remain unclear. This study aimed to analyze the 5-year clinical outcomes of thoracic endovascular aortic repair of chronic type B aortic dissection, compare the differences between patients with and without adverse aortic events (AAEs), and identify risk factors for AAEs. Methods and Results Patients who underwent thoracic endovascular aortic repair of chronic type B aortic dissection from January 2009 to June 2017 were retrospectively enrolled. The primary end points were AAEs, including aorta-related death, procedural complications, and disease progression requiring reintervention. Clinical outcomes were described at the 5-year follow-up visit. The secondary end point was the comparison of the results between patients with and without AAEs. Univariable and multivariable logistic analyses were used to identify potential risk factors for AAEs. A total of 214 patients were enrolled. AAEs occurred in 46 (21.5%) patients. Compared with patients without AAEs, those with AAEs had higher rates of residual type A aortic dissection (26.1% versus 4.2%, <0.001) and aortic diameter ≥5.5 cm (69.6% versus 11.3%, <0.001), and a lower rate of complete false lumen thrombosis (23.9% versus 89.9%, <0.001). Meanwhile, the median interval from symptom onset to intervention was longer in patients with AAEs (26 months versus 12 months, =0.004). Partial or no false lumen thrombosis (adjusted odds ratio [AOR], 14.71 [95% CI, 5.67-38.14; <0.001]) and aortic diameter ≥5.5 cm (AOR, 10.16 [95% CI, 3.86-26.73; <0.001]) were identified as independent risk factors for AAEs. Conclusions While thoracic endovascular aortic repair of chronic type B aortic dissection might be challenging in some cases, its long-term outcomes appeared promising as this treatment was effective in preventing catastrophic aortic events. Patients with AAEs showed higher rates of residual type A aortic dissection and aortic diameter ≥5.5 cm, a lower rate of complete false lumen thrombosis, and a longer median interval from symptom onset to intervention. Failure of complete false lumen thrombosis and an aortic diameter ≥5.5 cm were predictors of AAEs.
经胸主动脉腔内修复术治疗慢性 B 型主动脉夹层存在一定挑战，其长期预后尚不清楚。本研究旨在分析慢性 B 型主动脉夹层经胸主动脉腔内修复术的 5 年临床转归，比较发生不良主动脉事件（AAE）与未发生 AAE 的患者之间的差异，并确定 AAE 的风险因素。
回顾性纳入 2009 年 1 月至 2017 年 6 月接受慢性 B 型主动脉夹层经胸主动脉腔内修复术的患者。主要终点为 AAE，包括与主动脉相关的死亡、手术并发症以及需要再次介入治疗的疾病进展。在 5 年随访时描述临床结局。次要终点是比较发生 AAE 与未发生 AAE 的患者之间的结果。采用单变量和多变量逻辑分析确定 AAE 的潜在风险因素。共纳入 214 例患者。46 例（21.5%）患者发生 AAE。与未发生 AAE 的患者相比，发生 AAE 的患者中残留型 A 主动脉夹层的发生率更高（26.1%比 4.2%，<0.001），主动脉直径≥5.5cm 的比例更高（69.6%比 11.3%，<0.001），完全假腔血栓形成的比例更低（23.9%比 89.9%，<0.001）。同时，发生 AAE 的患者从症状出现到干预的中位时间间隔更长（26 个月比 12 个月，=0.004）。部分或无假腔血栓形成（调整后比值比[OR]，14.71[95%CI，5.67-38.14；<0.001]）和主动脉直径≥5.5cm（调整后 OR，10.16[95%CI，3.86-26.73；<0.001]）被确定为 AAE 的独立风险因素。
尽管慢性 B 型主动脉夹层经胸主动脉腔内修复术在某些情况下可能具有挑战性，但从长期来看，这种治疗方法预防灾难性主动脉事件的效果是有效的，预后似乎较为乐观。发生 AAE 的患者中残留型 A 主动脉夹层和主动脉直径≥5.5cm 的比例更高，完全假腔血栓形成的比例更低，从症状出现到干预的中位时间间隔更长。不完全假腔血栓形成和主动脉直径≥5.5cm 是 AAE 的预测因素。
