Zhou Xiao-Biao, Chen Xin, Wang Zhan, Chen Ding-Qiang, Li Rui, Li Li, Xu Lin-Xi, Chen Zhi-Huang, Song Man, Huang Jian, Zhuang Jia-Wei, Cheng Gang-Yi, Xu Qing-Xin, Zhu Zhuang-Hui, Shan Zhong-Gui
Department of Cardiovascular Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
The School of Clinical Medicine, Fujian Medical University, Fujian, China.
BMC Cardiovasc Disord. 2025 Feb 11;25(1):91. doi: 10.1186/s12872-025-04533-x.
To analyze the outcome of 147 cases of type B aortic dissection with thoracic endovascular aortic repair (TEVAR).
We systematically reviewed 147 patients of type B aortic dissection with stent graft deployment in zone 2 or zone 3 by TEVAR from January 2012 to December 2022. These patients were observed by computed tomography angiography after the first and third months and annually thereafter during follow-up. Statistical analysis was performed by SPSS.16.
The stent graft of 107 patients was deployed in zone 3, and the stent graft of 40 patients was deployed in zone 2. Severe dissection and surgery-related complications after TEVAR occurred in 19 patients, with complications arising more frequently in zone 2 than in zone 3 (12/40 vs. 7/107, P < 0.005). Endoleak was detected in 10 (6.8%, 10/147) cases, which included 6 cases of endoleak in zone 2, exceeding the 4 cases of endoleak in zone 3 (6/40 vs. 4/107, P < 0.05). Twelve (8.16%, 12/147) cases underwent re-intervention, and the 8 patients who underwent re-intervention in zone 2 exceeded the 4 patients who underwent re-intervention in zone 3 (8/40 vs. 4/107, P < 0.05). One case of subclavian steal in zone 2 (0.68%, 1/147). Two (1.36%, 2/147) cases died after TEVAR. The 1-year, 3-year, and 5-year overall survival rates were 99.3%, 98.6%, and 98.6%, respectively. The re-intervention rates were 5.4%, 7.5%, and 8.2%, respectively. The re-intervention rates in zone 2 were 15%, 20%, and 20%, respectively. The re-intervention rates in zone 3 were 1.9%, 2.8%, and 3.7%, respectively.
TEVAR is the major treatment to use if the stent graft can be deployed in zone 3. However, with the higher rate of complications and re-intervention after TEVAR, for patients whose stent graft can only be deployed in zone 2, it is not recommended that TEVAR be chosen as the preferred treatment.
分析147例B型主动脉夹层行胸主动脉腔内修复术（TEVAR）的疗效。
我们系统回顾了2012年1月至2022年12月期间147例行TEVAR且支架移植物植入2区或3区的B型主动脉夹层患者。这些患者在术后第1个月和第3个月进行计算机断层扫描血管造影观察，此后每年随访。采用SPSS.16进行统计分析。
107例患者的支架移植物植入3区，40例患者的支架移植物植入2区。TEVAR术后19例出现严重夹层及手术相关并发症，2区并发症发生率高于3区（12/40 vs. 7/107，P＜0.005）。10例（6.8%，10/147）检测到内漏，其中2区6例内漏，超过3区的4例（6/40 vs. 4/107，P＜0.05）。12例（8.16%，12/147）接受了再次干预，2区接受再次干预的8例患者超过3区的4例（8/40 vs. 4/107，P＜0.05）。2区发生1例锁骨下动脉窃血（0.68%，1/147）。2例（1.36%，2/147）TEVAR术后死亡。1年、3年和5年总生存率分别为99.3%、98.6%和98.6%。再次干预率分别为5.4%、7.5%和8.2%。2区再次干预率分别为15%、20%和20%。3区再次干预率分别为1.9%、2.8%和3.7%。
如果支架移植物能植入3区，TEVAR是主要治疗方法。然而，由于TEVAR术后并发症和再次干预率较高，对于支架移植物只能植入2区的患者，不建议将TEVAR作为首选治疗方法。
