通过比较胸主动脉瘤的治疗结果，评估近端着陆区1和2的胸主动脉腔内修复术治疗B型主动脉夹层的有效性。
Effectiveness of Proximal Landing Zone 1 and 2 Thoracic Endovascular Aortic Repair for Type B Aortic Dissection by Comparing Outcomes With Thoracic Arch Aneurysm.
作者信息
Kudo Tomoaki, Kuratani Toru, Sawa Yoshiki, Miyagawa Shigeru
机构信息
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
出版信息
J Endovasc Ther. 2025 Feb;32(1):170-184. doi: 10.1177/15266028231174407. Epub 2023 May 24.
PURPOSE
Hybrid thoracic endovascular aortic repair (TEVAR) for aortic arch aneurysms is a minimally invasive procedure with improved results. This study aimed to clarify the effectiveness and expand the possibilities of zone 1 and 2 landing TEVAR for type B aortic dissection (TBAD) using our treatment strategy.
METHODS
This retrospective, single-center, observational cohort study included 213 patients (TBAD, n=69; thoracic arch aneurysm [TAA], n=144; median age, 72 years; median follow-up period, 6 years) from May 2008 to February 2020. The following conditions were satisfied before performing zone 1 and 2 landing TEVAR: TBAD; proximal landing zone (LZ): diameter <37 mm, length >15 mm, and nondissection area, proximal stent-graft: size ≤40 mm and oversizing rate: 10% to 20%, and TAA; proximal LZ: diameter ≤42 mm and length >15 mm, proximal stent-graft: size ≤46 mm and oversizing rate: 10% to 20%. Of the 69 patients in the TBAD group, 34 (49.3%) had patent false lumen (PFL), and 35 (50.7%) had false lumen partial thrombosis (FLPT), including ulcer-like projections. Emergency procedures were performed in 33 (15.5%) patients.
RESULTS
There were no significant differences in the in-hospital mortality (TBAD: 1.5% vs TAA: 0.7%, p=0.544) or the in-hospital aortic complications (TBAD: n=1 vs TAA: n=5, p=0.666). Retrograde type A dissection was not observed in the TBAD group. The aortic event-free rates at 10 years were 89.7% (95% confidence interval [CI]: 78.7%-95.3%) and 87.9% (95% CI: 80.3%-92.8%) in the TBAD and TAA groups, respectively (log-rank p=0.636). In the TBAD group, the early and late outcomes were not significantly different between the PFL and FLPT groups.
CONCLUSION
Satisfactory early and long-term results were obtained with zone 1 and 2 landing TEVAR. The TBAD cases had the same good results as the TAA cases. Using our strategy, we especially might reduce complications and be an effective treatment for acute complicated TBAD.
CLINICAL IMPACT
This study aimed to clarify the effectiveness and expand the possibilities of zones 1 and 2 landing TEVAR for type B aortic dissection (TBAD) using our treatment strategy. Satisfactory early and long-term results in the TBAD and thoracic arch aneurysm (TAA) groups were obtained with zones 1 and 2 landing TEVAR. The TBAD cases had the same good results as the TAA cases. Using our strategy, we especially might reduce complications and be an effective treatment for acute complicated TBAD.
目的
杂交性胸段血管腔内主动脉修复术（TEVAR）治疗主动脉弓部动脉瘤是一种微创手术，效果良好。本研究旨在通过我们的治疗策略，阐明1区和2区锚定TEVAR治疗B型主动脉夹层（TBAD）的有效性并拓展其应用可能性。
方法
本回顾性、单中心观察性队列研究纳入了2008年5月至2020年2月的213例患者（TBAD患者69例；胸主动脉弓部动脉瘤[TAA]患者144例；中位年龄72岁；中位随访期6年）。在进行1区和2区锚定TEVAR之前需满足以下条件：TBAD；近端锚定区（LZ）：直径<37 mm，长度>15 mm，且为无夹层区域，近端覆膜支架：尺寸≤40 mm，且超尺寸率为10%至20%；以及TAA；近端LZ：直径≤42 mm，长度>15 mm，近端覆膜支架：尺寸≤46 mm，且超尺寸率为10%至20%。在TBAD组的69例患者中，34例（49.3%）存在通畅的假腔（PFL），35例（50.7%）存在假腔部分血栓形成（FLPT），包括溃疡样突出。33例（15.5%）患者接受了急诊手术。
结果
住院死亡率（TBAD：1.5% vs TAA：0.7%，p = 0.544）或住院期间主动脉并发症（TBAD：n = 1 vs TAA：n = 5，p = 0.666）无显著差异。TBAD组未观察到逆行性A型夹层。TBAD组和TAA组10年时无主动脉事件发生率分别为89.7%（95%置信区间[CI]：78.7% - 95.3%）和87.9%（95% CI：80.3% - 92.8%）（对数秩检验p = 0.636）。在TBAD组中，PFL组和FLPT组的早期和晚期结果无显著差异。
结论
1区和2区锚定TEVAR取得了满意的早期和长期结果。TBAD病例与TAA病例的效果相同。采用我们的策略，尤其可能减少并发症，是治疗急性复杂性TBAD的有效方法。
临床意义
本研究旨在通过我们的治疗策略，阐明1区和2区锚定TEVAR治疗B型主动脉夹层（TBAD）的有效性并拓展其应用可能性。1区和2区锚定TEVAR在TBAD组和胸主动脉弓部动脉瘤（TAA）组均取得了满意的早期和长期结果。TBAD病例与TAA病例的效果相同。采用我们的策略，尤其可能减少并发症，是治疗急性复杂性TBAD的有效方法。
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