Mittal Apeksha, Aggarwal Pankaj, Singh Harkant, Singhal Manphool, Sharma Arun, Irshad Mohamed M R, Santoki Nishit, Kumar Nitish, Garg Dollphy, Aswal Chandra Shekhar Singh, Soni Richa, George A Arun
Cardiothoracic Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India.
Department of Anesthesia, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India.
Braz J Cardiovasc Surg. 2025 May 5;40(3):e20240243. doi: 10.21470/1678-9741-2024-0243.
Surgical treatment of type A aortic dissection is essentially palliative. Many patients who undergo the procedure still have a dissection flap in the residual aorta, with a persistent patent or partially thrombosed false lumen leaving them susceptible to the dilatation of distal aorta and aneurysm formation.
Patients who had undergone surgery for type A aortic dissection from January 2015 till December 2022 were recruited into the study. Two follow-up computed tomography scans were performed at least six months apart, the first one at least one month after the surgery.
A persistent dissection flap was found in 34 (68%) patients. All segments of residual distal aorta showed dilatation with time. Growth rate was maximum for abdominal aorta - 3.1 (1.6 - 5.4) mm/year. Patency of false lumen was the only significant factor associated with growth of lower descending thoracic aorta and abdominal aorta (P<0.05). Maximum growth was seen in the patients with partial thrombosis of the false lumen, followed by those with patent false lumen. Two patients with partially thrombosed false lumens required reintervention in the form of endovascular stenting.
Patients after surgery for type A aortic dissection with partially thrombosed false lumens are more prone to aortic dilatation. Regular follow-up of these patients with computed tomography aortogram can lead to timely detection of these sequalae and intervention as needed.
A型主动脉夹层的外科治疗本质上是姑息性的。许多接受该手术的患者在残余主动脉中仍有夹层瓣，存在持续通畅或部分血栓形成的假腔，这使他们易患远端主动脉扩张和动脉瘤形成。
纳入2015年1月至2022年12月期间接受A型主动脉夹层手术的患者进行研究。进行两次间隔至少六个月的计算机断层扫描随访，第一次在手术后至少一个月进行。
34例（68%）患者发现有持续的夹层瓣。残余远端主动脉的所有节段均随时间出现扩张。腹主动脉的生长速率最高，为3.1（1.6 - 5.4）mm/年。假腔通畅是与胸降主动脉下段和腹主动脉生长相关的唯一显著因素（P<0.05）。假腔部分血栓形成的患者生长最大，其次是假腔通畅的患者。两名假腔部分血栓形成的患者需要进行血管内支架置入的再次干预。
A型主动脉夹层手术后假腔部分血栓形成的患者更容易发生主动脉扩张。对这些患者定期进行计算机断层扫描主动脉造影随访可及时发现这些后遗症并根据需要进行干预。
