Kato Hiroaki, Kato Noriyuki, Ouchi Takafumi, Higashigawa Takatoshi, Ito Hisato, Nakajima Ken, Chino Shuji, Tokui Toshiya, Mizumoto Toru, Oue Kensuke, Ichikawa Yasutaka, Sakuma Hajime
Department of Radiology, Mie University Hospital, Tsu, Mie, Japan.
Department of Cardiovascular Surgery, Mie University Hospital, Tsu, Mie, Japan.
Ann Vasc Dis. 2024 Sep 25;17(3):248-254. doi: 10.3400/avd.oa.24-00036. Epub 2024 Jun 18.
This study aims to investigate the efficacy of thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD) complicated by malperfusion. This retrospective study included patients who underwent TEVAR for the treatment of TBAD complicated by malperfusion from June 1998 to June 2022 in four institutions. In addition to the common outcomes, including short- and medium-term mortality and morbidity, the preservation of each organ was investigated. A total of 23 patients were included in this analysis. The 30-day mortality was 4% (1/23) of the patients. The overall survival rate was 87% at 1 year. The preservation rate of each organ was 33% (4/12) for the visceral organs, 85% (17/20) for the kidneys, and 100% (18/18) for the legs. Fisher's exact test showed a significant difference in the preservation rate between the viscera and the other organs ( = 0.018 vs. kidneys, = 0.0025 vs. legs). It was shown that the survival rate of patients with visceral malperfusion was significantly lower than that of patients with non-visceral malperfusion ( = 0.006). In terms of mortality, TEVAR showed satisfactory results. The preservation of visceral organs was still challenging even with TEVAR and adjunctive measures.
本研究旨在探讨胸主动脉腔内修复术（TEVAR）治疗合并灌注不良的B型主动脉夹层（TBAD）的疗效。这项回顾性研究纳入了1998年6月至2022年6月期间在四家机构接受TEVAR治疗合并灌注不良的TBAD患者。除了包括短期和中期死亡率及发病率等常见结局外，还对各器官的保留情况进行了研究。本分析共纳入23例患者。患者的30天死亡率为4%（1/23）。1年时的总生存率为87%。内脏器官的保留率为33%（4/12），肾脏为85%（17/20），下肢为100%（18/18）。Fisher精确检验显示，内脏与其他器官的保留率存在显著差异（与肾脏相比，P = 0.018；与下肢相比，P = 0.0025）。结果表明，内脏灌注不良患者的生存率显著低于非内脏灌注不良患者（P = 0.006）。在死亡率方面，TEVAR显示出令人满意的结果。即使采用TEVAR及辅助措施，内脏器官的保留仍然具有挑战性。
