Endovascular repair of residual intimal tear or distal new entry after frozen elephant trunk for type A aortic dissection
Endovascular repair of residual intimal tear or distal new entry after frozen elephant trunk for type A aortic dissection
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DOI：
10.21037/jtd.2017.03.04
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发表时间：
2017-03-01
影响因子：
2.5
通讯作者：
Sun, Li-Zhong
中科院分区：
文献类型：
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作者：
Pan, Xu-Dong;Li, Bin;Sun, Li-Zhong
背景资料：在A型夹层患者中，冷冻象鼻（FET）手术后残留夹层和新的远端入口撕裂对长期预后有不良影响。治疗包括开放和腔内修复术，而临床经验有限。我们评估胸主动脉腔内修复术（TEVAR）在治疗A型主动脉夹层（TAAD）患者FET后残余内膜撕裂或远端新入口撕裂的有效性。方法：2003年5月至2013年4月，我们对1,003例TAAD患者进行了FET和全弓置换术。其中，23例患者（2.3%）在FET后平均2.0 +/- 1.6年时因远端新进入（n=2）或残余内膜撕裂（n=21）需要TEVAR。平均年龄为50.1 ± 11.5岁。结果：手术成功率100%。86.9%（20/23）的远端锚定区位于第11胸椎（T11）上方。TEVAR术后早期未发生死亡或任何截瘫或卒中。平均随访时间为2.8 ± 1.7年（0.3-6.4），完成率为100%。1例非Marfan患者在TEVAR后4个月死于远端主动脉破裂。无晚期卒中或截瘫发生。3年和5年生存率分别为95.7%（95% CI，72.9-99.4%）。CTA检测到91.3%（21/23）的患者降主动脉覆膜支架周围血栓导致的假腔闭塞。结论：这些早期和中期结果显示了TEVAR在TAAD患者FET后闭塞残余内膜撕裂或远端新入口的有效性。TEVAR可能是TAAD患者FET后远端新进入或残余内膜撕裂的替代方法。
Background: In patients with type A dissection, residual dissection and new distal entry tears following the frozen elephant trunk (FET) procedure adversely affect long-term prognosis. Management include open and endovascular repair, while clinical experience is limited. We evaluate the efficacy of thoracic endovascular aortic repair (TEVAR) in management of residual intimal tear or distal new entry tear following FET in patients with type A aortic dissection (TAAD).Methods: Between May 2003 and April 2013, we performed FET and total arch replacement for 1,003 patients with TAAD. Among these, 23 patients (2.3%) required TEVAR for distal new entry (n=2) or residual intimal tear (n=21) at a mean of 2.0 +/- 1.6 years after FET. Mean age was 50.1 +/- 11.5 years. Marfan syndrome was seen in 2 patients (8.7%).Results: Procedural success was 100%. The distal landing zone was above the 11th thoracic vertebra (T11) in 86.9% (20/23). Neither death nor any paraplegia or stroke occurred early after TEVAR. Follow-up was complete in 100% averaging 2.8 +/- 1.7 years (0.3-6.4). One non-Marfan patient died of distal aortic rupture at 4 months after TEVAR. No late stroke or paraplegia occurred. Survival was 95.7% (95% CI, 72.9-99.4%) at 3 and 5 years, respectively. CTA detected false lumen obliteration by thrombus around the endograft in the descending aorta in 91.3% (21/23) of patients.Conclusions: These early and midterm outcomes show the efficacy of TEVAR in obliterating the residual intimal tear or distal new entry after FET in patients with TAAD. TEVAR may be an alternative approach to distal new entry or residual intimal tear following FET for patients with TAAD.