Early outcomes after endovascular management of acute, complicated type B aortic dissection
Early outcomes after endovascular management of acute, complicated type B aortic dissection
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DOI：
10.1016/j.jvs.2008.09.071
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发表时间：
2009-03-01
影响因子：
4.3
通讯作者：
Lee, W. Anthony
中科院分区：
文献类型：
--
作者：
Feezor, Robert J.;Martin, Tomas D.;Lee, W. Anthony
目的：急性、复杂的B型主动脉夹层的手术治疗与显着的发病率和死亡率相关。本研究探讨了血管内治疗这种病理的可行性和安全性。我们回顾了2005年至2007年在一家机构前瞻性维护的胸血管内数据库和病历。研究组包括急性复杂性B型夹层，定义为症状持续时间：514天，涉及假腔破裂、灌注不良、顽固性疼痛或不受控制的高血压。所有修复均使用TAG器械（W. L.戈尔和同事，弗拉格斯塔夫，亚利桑那州）。选择30天或在医院的结果进行了验证。在研究期间进行的216例胸主动脉瘤腔内修复术中，33例（15%）为急性复杂B型夹层。有8名妇女（24%）。平均年龄为61 ± 15岁。症状的平均持续时间为2.9 +/- 4.1（中位数，1）天。修复适应症包括15例患者（46%）的破裂和11例（33%）的肠系膜/肾脏/下肢灌注不良。平均透视时间和造影剂体积分别为30 ± 16分钟和176 ± 55 mL。8例（73%）I/I灌注不良患者需要分支血管支架植入术。30天住院死亡率为21%（7/33）。死亡原因包括3例心脏骤停，2例进行性多系统器官衰竭，1例破裂，1例不明原因。76%的患者发生了至少一种严重并发症，包括11例呼吸衰竭（33%）、5例永久性脊髓缺血（15%）、4例需要透析的肾衰竭（12%）和4例卒中（12%）。平均术后住院时间为17.2 +/- 16.5天，只有14例（42%）出院回家。急性复杂B型夹层的急诊腔内修复术与显著的死亡率和发病率相关。这种疗法在治疗这种致命问题中的总体作用应该更好地定义，并与其他手术或介入治疗方案进行比较，然后再普遍采用。（J Vasc Surg 2009;49：561-7.）
Objectives: Surgical management of acute, complicated type B aortic dissection is associated with significant morbidity and mortality. This study examined the feasibility and safety of endovascular treatment of this pathology.Methods. We reviewed a prospectively maintained thoracic endovascular database and medical records at a single institution from 2005 to 2007. The study group comprised of acute, complicated type B dissections, defined as duration of symptoms :514 days and involving either false lumen rupture, malperfusion, intractable pain, or uncontrolled hypertension. All repairs were performed using the TAG device (W. L. Gore and Associates, Flagstaff, Ariz). Select 30-day or in-hospital outcomes were reported.Results. Of the 216 thoracic endovascular aortic aneurysm repairs performed during the study period, 33 (15%) were for acute, complicated type B dissections. There were eight women (24%). The mean age was 61 +/- 15 years. The average duration of symptoms was 2.9 +/- 4.1 (median, 1) days. The indications for repair included rupture in 15 patients (46%) and mesenteric/renal/lower extremity malperfusion in 11 (33%). Mean fluoroscopy time and contrast volume were 30 16 minutes and 176 +/- 55 mL, respectively. Eight (73%) of I I patients with malperfusion required branch vessel stenting. The 30-day in-hospital mortality was 21% (7 of 33). Causes of death included cardiac arrest in 3, progressive multisystem organ failure in 2, rupture in I and unknown in 1. At least one major complication occurred in 76% of the patients, including respiratory failure in 11 (33%), permanent spinal cord ischemia in 5 (15%), renal failure requiring dialysis in 4 (12%), and stroke in 4 (12%). The mean postoperative length of stay was 17.2 +/- 16.5 days, and only 14 (42%) were discharged to home.Conclusions. Emergency endovascular repair of acute, complicated type B dissection is associated with significant mortality and morbidity. The overall role of this therapy in the treatment of this lethal problem should be better defined and compared with other surgical or interventional options before being generally adopted. (J Vasc Surg 2009;49:561-7.)