胸主动脉腔内修复术治疗急性 Stanford B 型主动脉夹层合并逆行性 A 型主动脉壁内血肿的安全性和有效性。
Safety and efficacy of thoracic endovascular aortic repair for acute Stanford type B aortic dissection with retrograde type A intramural hematoma.
机构信息
Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China; Institute of Vascular Diseases, Central South University, Changsha, China.
Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT.
出版信息
J Vasc Surg. 2023 Jul;78(1):61-69.e4. doi: 10.1016/j.jvs.2023.02.021. Epub 2023 Mar 13.
OBJECTIVE
The aim of this study was to evaluate safety and efficacy of thoracic endovascular aortic repair (TEVAR) for acute Stanford type B aortic dissection (TBAD) with retrograde type A intramural hematoma (TAIMH).
METHODS
Patients with acute TBAD with retrograde TAIMH treated with TEVAR between January 1, 2014, to March 31, 2022, were retrospectively reviewed. Aortic diameter and distance were measured using the 3D Slicer image computing platform. Patients' characteristics, procedural, in-hospital and follow-up data, and aortic remodeling were analyzed.
RESULTS
Fifty-two patients (average age, 52.6 years; 42 males [80.8%]) were included. The median interval from symptom onset to TEVAR was 11 days (interquartile range, 7.0-16.8 days). The maximal diameter of the ascending aorta (AA) was <50 mm, and the hematoma thickness in the AA was ≤10 mm in all patients. Both the in-hospital and 30-day mortality rates were 0%. The 30-day complication rate was 11.5%. The overall cumulative survival rates were 100% at 1 year, 97.1% at 3 years, and 92.6% at 5 years. Four of 52 patients (7.7%) developed retrograde type A aortic dissection at 10 days to 4 months postoperatively, and one of 52 patients (1.9%) developed an isolated AA dissection 4 months postoperatively; these five patients were treated and alive at late follow-up in March 2022. The rates of cumulative freedom from thoracic aortic re-intervention were 93.7% at 1 year and 90.7% at 5 years. Positive AA remodeling was observed in 92.3% (48/52) of patients during follow-up. The maximal diameter of AA (mean ± standard error of mean) at admission was 42.7 ± 0.8 mm, which decreased to 39.5 ± 0.9 mm at last follow-up. The maximal AA hematoma thickness at admission was 7.6 ± 0.3 mm, which reduced to 2.2 ± 0.9 mm at last follow-up.
CONCLUSIONS
For selected patients of acute Stanford TBAD with retrograde TAIMH, endovascular repair may be a safe, effective, and durable alternative treatment, if the maximum diameter of the AA is <50 mm and the intramural hematoma thickness in the AA is ≤10 mm.
目的
本研究旨在评估经胸主动脉腔内修复术（TEVAR）治疗急性 Stanford 型 B 型主动脉夹层（TBAD）伴逆行型 A 型主动脉壁内血肿（TAIMH）的安全性和疗效。
方法
回顾性分析 2014 年 1 月 1 日至 2022 年 3 月 31 日期间接受 TEVAR 治疗的急性 TBAD 伴逆行 TAIMH 患者。使用 3D Slicer 图像计算平台测量主动脉直径和距离。分析患者的特征、手术、住院和随访数据以及主动脉重塑情况。
结果
共纳入 52 例患者（平均年龄 52.6 岁；42 例男性[80.8%]）。从症状发作到 TEVAR 的中位时间为 11 天（四分位距 7.0-16.8 天）。所有患者升主动脉（AA）的最大直径<50mm，AA 内血肿厚度均≤10mm。住院期间和 30 天死亡率均为 0%。30 天并发症发生率为 11.5%。1 年、3 年和 5 年的总体累积生存率分别为 100%、97.1%和 92.6%。52 例患者中有 4 例（7.7%）在术后 10 天至 4 个月时发生逆行型 A 型主动脉夹层，52 例患者中有 1 例（1.9%）在术后 4 个月时发生孤立性 AA 夹层；这 5 例患者在 2022 年 3 月的晚期随访中得到治疗并存活。1 年和 5 年的累积免于胸主动脉再次干预率分别为 93.7%和 90.7%。52 例患者中有 48 例（92.3%）在随访期间出现 AA 正性重塑。入院时 AA 的最大直径（平均值±均数标准误）为 42.7±0.8mm，末次随访时降至 39.5±0.9mm。入院时 AA 最大血肿厚度为 7.6±0.3mm，末次随访时降至 2.2±0.9mm。
结论
对于急性 Stanford TBAD 伴逆行 TAIMH 的特定患者，如果升主动脉最大直径<50mm，AA 内血肿厚度≤10mm，血管内修复可能是一种安全、有效和持久的替代治疗方法。
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