Endovascular Repair of Acute and Chronic Aortic Type B Dissections Main Factors Affecting Aortic Remodeling and Clinical Outcome
Endovascular Repair of Acute and Chronic Aortic Type B Dissections Main Factors Affecting Aortic Remodeling and Clinical Outcome
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DOI：
10.1016/j.jcin.2015.10.027
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发表时间：
2016-01-25
影响因子：
11.3
通讯作者：
Catalano, Carlo
中科院分区：
文献类型：
--
作者：
Fanelli, Fabrizio;Cannavale, Alessandro;Catalano, Carlo
本研究的目的是评估胸主动脉腔内修复术（TEVAR）后影响急性和慢性B型主动脉夹层临床结局和形态学变化的因素。背景TEVAR后的主动脉重构可能与临床结局、并发症、方法对60例复杂B型急性主动脉夹层（AAD）和慢性主动脉夹层（CAD）患者行TEVAR术，分别治疗急性AAD 29例和慢性AAD 29例。31例），至少随访3年。使用计算机断层扫描图像，我们评估了真腔、假腔和总主动脉短轴直径。分析了与主动脉重塑和其他结局相关的六个手术因素。方差分析用于比较随访期间的短轴、假腔和真腔直径。单因素和多因素分析被用来评估程序因素和多个outcome. Results之间的关系，共100覆膜支架植入在60例急性主动脉夹层（AAD）和CAD连续患者。AAD患者的主动脉重构（包括假腔血栓形成和收缩）比CAD患者更显著，尤其是在前18个月内。值得注意的是，在AAD中，整个主动脉直径在覆膜支架头侧显著增加。仅在AAD组中，与覆膜支架后扩张相关的主动脉重塑增加。17例患者（28%）发生I型和II型内漏;在AAD中，覆膜支架展开后左锁骨下动脉栓塞与内漏发生风险降低显著相关，结论TEVAR术后的主动脉重构和临床结局可能受手术技术的影响，（急性而非慢性主动脉夹层患者左锁骨下动脉的后扩张和栓塞）。（J Am科尔Cardiol Intv 2016; 9：183-91）（C）美国心脏病学会基金会2016年。
OBJECTIVES The aim of this study was to assess factors influencing the clinical outcome and morphological changes of acute and chronic type B aortic dissection after thoracic endovascular aortic repair (TEVAR).BACKGROUND Aortic remodeling after TEVAR may be associated with clinical outcome, complications, and endoleak development.METHODS Sixty cases of TEVAR for complicated type B acute aortic dissection (AAD) (n = 29) and chronic aortic dissection (CAD) (n = 31) with a minimum follow-up of 3 years were retrospectively reviewed. Using computed tomography images, we assessed true lumen, false lumen, and total aortic short-axis diameters. Six procedural factors were analyzed in relation to aortic remodeling and other outcomes. Analysis of variance was used to compare short-axis, false lumen, and true lumen diameters during the follow-up period. Univariate and multivariate analyses were used to assess the relationship between procedural factors and multiple outcomes.RESULTS A total of 100 stent grafts were implanted in 60 consecutive patients with acute aortic dissection (AAD) and CAD. Aortic remodeling consisting of false lumen thrombosis and shrinkage was more prominent in AAD than in CAD, especially within the first 18 months. Of note, the entire aortic diameter increased significantly cephalad to the stent graft in AAD. Only in the AAD group there was increased aortic remodeling related to post-dilation of the stent graft. Type I and II endoleaks occurred in 17 patients (28%); in AAD, embolization of the left subclavian artery after stent graft deployment was significantly associated with a lower risk of endoleak development, but this was not evident in CAD.CONCLUSIONS Aortic remodeling and clinical outcome after TEVAR can be influenced by procedural techniques (post-dilation and embolization of the left subclavian artery in patients with acute but not chronic aortic dissection). (J Am Coll Cardiol Intv 2016; 9: 183-91) (C) 2016 by the American College of Cardiology Foundation.