Department of General Surgery, Binhai People's Hospital, Yancheng, Jiangsu Province, People's Republic of China.
Department of Clinical Laboratory, Binhai People's Hospital, Yancheng, Jiangsu Province, People's Republic of China.
Medicine (Baltimore). 2022 Nov 11;101(45):e31301. doi: 10.1097/MD.0000000000031301.
To compare the safety and efficacy of thoracic endovascular aortic repair (TEVAR) and optimal medical treatment (OMT) for type B penetrating aortic ulcer (PAU) associated with intramural hematoma (IMH). From January 2015 to December 2018, 68 consecutive patients with acute type B PAU associated with IMH were enrolled in the study. TEVAR was performed following initially OMT in 30 patients (group A), and OMT was performed in 38 patients (group B). Primary outcome was aortic-related mortality. Secondary outcomes included all-cause mortality, aortic-related adverse events, and complete aortic remodeling. There was no significant difference in the baseline characteristics of patients among the 2 groups except for the depth of PAU and the thickness of IMH. Patients in group B had a significant higher risk of aortic-related mortality (13.3% vs 0%, P = .045), as the same to aortic-related adverse events during follow-up. Compared to OMT, TEVAR contributed to the favorable aortic remodeling more significantly during the mid-term follow-up (85.7% vs 18.2%, P < .001). Comparing with optimal medical repair, TEVAR for patients with PAU associated with IMH could promote the favorable aortic remolding more significantly and result in lower aortic-related mortality during mid-term follow-up. It should be considered as the first-line therapeutic option when intervention is required.
比较胸主动脉腔内修复术（TEVAR）和最佳药物治疗（OMT）治疗伴壁内血肿（IMH）的 B 型穿透性主动脉溃疡（PAU）的安全性和疗效。2015 年 1 月至 2018 年 12 月，连续纳入 68 例急性 B 型伴 IMH 的 PAU 患者。30 例患者（A 组）初始 OMT 后行 TEVAR，38 例患者（B 组）行 OMT。主要终点为主动脉相关死亡率。次要终点包括全因死亡率、主动脉相关不良事件和完全主动脉重塑。两组患者的基线特征除 PAU 深度和 IMH 厚度外无显著差异。B 组主动脉相关死亡率（13.3% vs. 0%，P=0.045）和随访期间主动脉相关不良事件的风险显著更高。与 OMT 相比，TEVAR 更有助于中期随访中更显著的主动脉重塑（85.7% vs. 18.2%，P<0.001）。与最佳药物修复相比，对于伴 IMH 的 PAU 患者，TEVAR 能更显著地促进有利的主动脉重塑，并在中期随访中降低主动脉相关死亡率。当需要介入治疗时，应将其视为一线治疗选择。
