Wu Jinlin, Wu Yanfen, Li Fei, Zhuang Donglin, Cheng Yunqing, Chen Zerui, Yang Jue, Liu Jie, Li Xin, Fan Ruixin, Sun Tucheng
Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Front Cardiovasc Med. 2023 Feb 23;10:1002832. doi: 10.3389/fcvm.2023.1002832. eCollection 2023.
Isolated abdominal aortic dissection (IAAD) is extremely rare, with its optimal treatment and intervention timing remaining poorly understood. We aimed to study the natural history of IAAD and facilitate better clinical decision.
Consecutive patients admitted to our institution from January 2016 to April 2021 were enrolled and followed up prospectively. All-cause death was taken as the primary endpoint.
A total of 68 patients with IAAD were included. The mean age at presentation was 61.2 ± 14.8 (Range: 26.0, 93.0) years and 55 (80.9%) were male. A total of 38 (55.9%) patients were treated conservatively, 27 (39.7%) received endovascular aneurysm repair (EVAR), and 3 (4.4%) underwent open surgery. After a mean follow-up of 2.4 years (Range: 0.1, 5.5), 9 (13.2%) patients died, 8 of whom (21.0%) were treated conservatively and 1 EVAR (3.7%). Compared with EVAR/open surgery, patient treated conservatively had a much worse survival ( = 0.043). There was no significant difference between different IAAD aortic sizes regarding mortality ( = 0.220). Patients with completely thrombosed false lumen fared improved survival rate, followed by partial thrombosis and patency, respectively, although not significantly ( = 0.190). No significant difference was observed between male and female concerning survival rate ( = 0.970). Patients without symptoms had a significantly improved survival ( = 0.048).
On the basis of patients' preference and surgeons' experience, a more aggressive treatment regimen for IAAD should be considered, with EVAR being the first choice, especially for those with persistent symptoms and patent false lumen, regardless of sex, age, or aortic size.
孤立性腹主动脉夹层（IAAD）极为罕见，其最佳治疗方法和干预时机仍知之甚少。我们旨在研究IAAD的自然病程，以促进更好的临床决策。
纳入2016年1月至2021年4月在我院连续收治的患者，并进行前瞻性随访。全因死亡作为主要终点。
共纳入68例IAAD患者。就诊时的平均年龄为61.2±14.8（范围：26.0，93.0）岁，55例（80.9%）为男性。共有38例（55.9%）患者接受保守治疗，27例（39.7%）接受血管内动脉瘤修复术（EVAR），3例（4.4%）接受开放手术。平均随访2.4年（范围：0.1，5.5）后，9例（13.2%）患者死亡，其中8例（21.0%）接受保守治疗，1例EVAR（3.7%）。与EVAR/开放手术相比，接受保守治疗的患者生存率差得多（P = 0.043）。不同IAAD主动脉大小的死亡率之间无显著差异（P = 0.220）。假腔完全血栓形成的患者生存率有所提高，其次分别为部分血栓形成和通畅，但差异无统计学意义（P = 0.190）。男性和女性的生存率之间无显著差异（P = 0.970）。无症状患者的生存率显著提高（P = 0.048）。
根据患者的偏好和外科医生的经验，应考虑对IAAD采取更积极的治疗方案，EVAR为首选，特别是对于那些有持续症状和假腔通畅的患者，无论性别、年龄或主动脉大小。
