A Novel Solution for Distal Dilation of Chronic Dissection After Repair Involving Visceral Branches: The Road Block Strategy.
A Novel Solution for Distal Dilation of Chronic Dissection After Repair Involving Visceral Branches: The Road Block Strategy.
复制标题
涉及内脏分支修复后慢性解剖远端扩张的新解决方案：路障策略
DOI：
10.3389/fcvm.2022.821260
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发表时间：
2022
影响因子：
3.6
通讯作者：
Jing Z
中科院分区：
文献类型：
--
作者：
Li Y;Li Z;Feng J;Feng R;Zhou J;Jing Z
尽管近年来血管内治疗取得了前所未有的进展，但对于慢性腹脏部主动脉夹层（CADAV）远端扩张患者，在主动脉修复后保持腹腔内脏动脉血流灌注并促进主动脉正向重构的最佳策略仍不清楚。本研究开发了一个路障策略（RBS）来解决这个难题。这项前瞻性单中心临床研究纳入了2015年1月至2019年12月接受RBS治疗的主动脉修复后出现CADAV远端扩张症状的患者，并定期随访至少2年。首先植入支架以覆盖远端撕裂并扩大真腔。器械栓塞诱导近端和远端节段性假腔血栓形成（FLT），远离重要分支的开口水平。13例患者成功行RBS。术前与最新随访结果在最大真腔直径（p < 0.05）、假腔血流面积（p < 0.001）、血腔与假腔面积之比（p < 0.05）方面差异均有统计学意义。住院及随访期间无主动脉破裂、重要分支闭塞、胸腹疼痛、死亡。我们的研究结果表明，RBS在治疗慢性主动脉夹层近端修复后的远端扩张，诱导假腔血栓形成，防止主动脉夹层恶化，维持腹部内脏动脉通畅方面是可行的。
Notwithstanding that unprecedented endovascular progress has been achieved in recent years, it remains unclear what is the best strategy to preserve the blood perfusion of abdominal visceral arteries and promote positive aortic remodeling in patients with distal dilatation of chronic aortic dissection in abdominal visceral part (CADAV) after aortic repair. The present study developed a Road Block Strategy (RBS) to solve this conundrum. This prospective single-center clinical study included patients suffering from symptomatic distal dilatation of CADAV after aortic repair treated with RBS from January 2015 to December 2019 and followed up regularly for at least 2 years. Stent grafts were implanted first to cover distal tears and expand the true lumen. Device embolization was performed to induce proximal and distal segmental false lumen thrombosis (FLT) apart from the level of the ostia of vital branches. Successful RBS was performed in 13 patients. Significant differences were found in maximum true lumen diameter (p < 0.05), blood flow area in false lumen (FL) (p < 0.001), and the ratio of blood lumen to FL area (p < 0.05) between the pre-procedure and the latest follow-up results. No aortic rupture, vital branches occlusion, thoracic and abdominal pain, or death occurred during hospitalization and follow-up. Our findings suggest that RBS is feasible in treating distal dilatation of chronic aortic dissection after prior proximal repair, inducing false lumen thrombosis, preventing deterioration of aortic dissection, and maintaining the patency of abdominal visceral arteries.
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影响因子：
2.6
作者：
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