急性主动脉夹层伴灌注不良综合征血管内治疗的中期临床结果
Midterm Clinical Outcomes of Endovascular Treatment for Acute Aortic Dissection with Malperfusion Syndrome.
作者信息
Kim La Eun, Park Jong Ha, Lee Han Cheol, Bae Mi Ju, You Ji Hoon
机构信息
Division of Cardiology, Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Pusan National University, Busan, Korea.
Department of Cardiovascular Surgery, Pusan National University Hospital, Pusan National University, Busan, Korea.
出版信息
Vasc Specialist Int. 2024 Jun 7;40:17. doi: 10.5758/vsi.240006.
PURPOSE
There is limited data on the midterm results of endovascular treatment for acute type B aortic dissection (TBAD) with malperfusion syndrome (MS), particularly in Asia. This study aimed to investigate the clinical outcomes of endovascular treatment of acute TBAD with MS.
MATERIALS AND METHODS
We retrospectively analyzed 27 patients who underwent endovascular treatment for acute TBAD with MS.
RESULTS
Among the 27 patients with TBAD and MS, malperfusion was observed in the isolated renal (44.4%), visceral (7.4%) and iliofemoral (25.9%) arteries, as well as their combinations (22.2%). The patients underwent thoracic endovascular aortic repair (TEVAR) only (25.9%), selective stenting only in arteries affected by malperfusion (22.2%), or combined treatment with TEVAR and selective stenting (51.9%). Primary technical success was achieved in all the patients. No inhospital mortality or early death within 30 days after operation occurred. The rates of stroke, limb ischemia, acute kidney injury, and reintervention at 30 days were 7.4%, 3.7%, 25.9%, and 3.7%, respectively. The mean follow-up period was 4.3±3.1 years. During the follow-up, the rates of death, stroke, maintenance hemodialysis, aneurysmal change, and reintervention were 0%, 3.7%, 7.4%, 7.4%, and 7.4%, respectively. Two patients required reintervention due to limb ischemia and aneurysmal changes in the distal portion of the stent graft. Computed tomography scans revealed a significant increase in aortic diameters in patients who underwent selective stenting compared to those who underwent TEVAR over a 3-year period, with changes in aortic area measuring 878.9 mm vs. 188.4 mm at the middle of the lesion (P=0.037), 303.7 mm vs. 22.8 mm at the level of the celiac trunk (P=0.025), and 442.9 mm vs. 37.3 mm at the level of the renal artery (P=0.019).
CONCLUSION
The endovascular treatment of acute TBAD with MS demonstrated a high primary technical success rate and promising short- and midterm clinical outcomes.
目的
关于急性B型主动脉夹层（TBAD）合并灌注不良综合征（MS）的血管内治疗中期结果的数据有限，尤其是在亚洲。本研究旨在探讨急性TBAD合并MS的血管内治疗的临床结局。
材料与方法
我们回顾性分析了27例行急性TBAD合并MS血管内治疗的患者。
结果
在27例TBAD合并MS患者中，孤立肾动脉（44.4%）、内脏动脉（7.4%）、髂股动脉（25.9%）及其组合（22.2%）出现灌注不良。患者仅接受胸主动脉腔内修复术（TEVAR）（25.9%）、仅对灌注不良受累动脉进行选择性支架置入（22.2%）或接受TEVAR与选择性支架置入联合治疗（51.9%）。所有患者均取得了初次技术成功。术后无院内死亡或术后30天内早期死亡发生。术后30天时，卒中、肢体缺血、急性肾损伤和再次干预的发生率分别为7.4%、3.7%、25.9%和3.7%。平均随访期为4.3±3.1年。随访期间，死亡、卒中、维持性血液透析、动脉瘤样改变和再次干预的发生率分别为0%、3.7%、7.4%、7.4%和7.4%。2例患者因肢体缺血和支架移植物远端动脉瘤样改变需要再次干预。计算机断层扫描显示，与接受TEVAR的患者相比，接受选择性支架置入的患者在3年期间主动脉直径显著增加，病变中部主动脉面积变化为878.9平方毫米对188.4平方毫米（P=0.037），腹腔干水平为303.7平方毫米对22.8平方毫米（P=0.025），肾动脉水平为442.9平方毫米对37.3平方毫米（P=0.019）。
结论
急性TBAD合并MS的血管内治疗显示出较高的初次技术成功率以及良好的短期和中期临床结局。
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