Betz Thomas, Pfister Karin, Schierling Wilma, Sachsamanis Georgios, Kasprzak Piotr, Oikonomou Kyriakos
Abteilung für Gefäßchirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland.
Klinik für Gefäßchirurgie und Endovaskularchirurgie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt am Main, Deutschland.
Zentralbl Chir. 2024 Oct;149(5):428-434. doi: 10.1055/a-2060-9864. Epub 2023 May 30.
There are many publications dealing with treatment options for uncomplicated type B aortic dissection (TBAD). Early TEVAR (Thoracic Endovascular Aortic Repair) may improve aortic-specific survival and delay disease progression in the long-term. Especially in patients with uncomplicated TBAD and additional high-risk features, preemptive TEVAR may improve late outcomes.We conducted a retrospective analysis of all patients treated for TBAD in our hospital between February 2017 and September 2021. Comorbidities, intraoperative data, 30-day mortality and postprocedural complications were analysed.During the above-mentioned period, 61 patients (38 males, median age 63 years) with TBAD were treated. Six patients received best medical treatment (BMT). 55 patients were treated by TEVAR and BMT. 11 patients (20%) had complicated TBAD, 12 patients (22%) had uncomplicated TBAD with high-risk features and 32 patients (58%) had uncomplicated TBAD. Technical success was 100%. No patient with uncomplicated TBAD died within the first 30 postoperative days. One patient with uncomplicated TBAD had a stroke after TEVAR. Two reinterventions were performed on day 7 and day 9 after TEVAR.Patients with uncomplicated TBAD could be treated by early TEVAR, with a low rate of perioperative complications. In patients with uncomplicated TEVAR and high-risk features, early TEVAR with BMT should be considered as the treatment of choice.
有许多出版物涉及单纯性B型主动脉夹层(TBAD)的治疗选择。早期胸主动脉腔内修复术(TEVAR)可能会提高主动脉特异性生存率,并长期延缓疾病进展。特别是在患有单纯性TBAD且具有其他高危特征的患者中,预防性TEVAR可能会改善远期预后。
我们对2017年2月至2021年9月期间在我院接受TBAD治疗的所有患者进行了回顾性分析。分析了合并症、术中数据、30天死亡率和术后并发症。
在上述期间,61例(38例男性,中位年龄63岁)TBAD患者接受了治疗。6例患者接受了最佳药物治疗(BMT)。55例患者接受了TEVAR和BMT治疗。11例(20%)患者患有复杂性TBAD,12例(22%)患者患有具有高危特征的单纯性TBAD,32例(58%)患者患有单纯性TBAD。技术成功率为100%。没有单纯性TBAD患者在术后30天内死亡。1例单纯性TBAD患者在TEVAR术后发生中风。在TEVAR术后第7天和第9天进行了两次再次干预。
单纯性TBAD患者可通过早期TEVAR进行治疗,围手术期并发症发生率较低。对于具有高危特征的单纯性TEVAR患者,应考虑早期TEVAR联合BMT作为首选治疗方法。