Endovascular Repair of Type B Aortic Dissection Long-term Results of the Randomized Investigation of Stent Grafts in Aortic Dissection Trial
Endovascular Repair of Type B Aortic Dissection Long-term Results of the Randomized Investigation of Stent Grafts in Aortic Dissection Trial
复制标题
DOI：
10.1161/circinterventions.113.000463
复制
发表时间：
2013-08-01
影响因子：
5.6
通讯作者：
Ince, Hueseyin
中科院分区：
文献类型：
--
作者：
Nienaber, Christoph A.;Kische, Stephan;Ince, Hueseyin
背景：胸主动脉血管内修复（TEVAR）是治疗B型主动脉夹层的一种方法。TEVAR治疗单纯夹层的长期预后和形态学尚不清楚。方法和结果：共140例稳定型B型主动脉夹层患者，先前随机分为最佳药物治疗和TEVAR组（n=72）和最佳药物治疗组（n=68），回顾性分析主动脉特异性、全因结局和疾病进展，采用指标手术后2至5年的里程碑式统计分析。采用Cox回归比较组间结果；所有的分析都基于治疗意图。5年后，TEVAR组的全因死亡率（11.1%对19.3%，P=0.13）、主动脉特异性死亡率（6.9%对19.3%，P=0.04）和进展（27.0%对46.1%，P=0.04）的风险低于单纯最佳药物治疗组。里程碑式分析表明TEVAR在2 - 5年的所有终点都有益处；例如，全因死亡率（0%对16.9%，P=0.0003）、主动脉特异性死亡率（0%对16.9%，P=0.0005）和疾病进展（4.1%对28.1%，P=0.004）；在1年零1个月的地标显示一致的结果。选择性TEVAR术后5年生存率的提高和疾病进展的减少在90.6%的病例中与支架移植诱导的假腔血栓形成相关
Background-Thoracic endovascular aortic repair (TEVAR) represents a therapeutic concept for type B aortic dissection. Long-term outcomes and morphology after TEVAR for uncomplicated dissection are unknown.Methods and Results-A total of 140 patients with stable type B aortic dissection previously randomized to optimal medical treatment and TEVAR (n=72) versus optimal medical treatment alone (n=68) were analyzed retrospectively for aorta-specific, all-cause outcomes, and disease progression using landmark statistical analysis of years 2 to 5 after index procedure. Cox regression was used to compare outcomes between groups; all analyses are based on intention to treat. The risk of all-cause mortality (11.1% versus 19.3%; P=0.13), aorta-specific mortality (6.9% versus 19.3%; P=0.04), and progression (27.0% versus 46.1%; P=0.04) after 5 years was lower with TEVAR than with optimal medical treatment alone. Landmark analysis suggested a benefit of TEVAR for all end points between 2 and 5 years; for example, for all-cause mortality (0% versus 16.9%; P=0.0003), aorta-specific mortality (0% versus 16.9%; P=0.0005), and for progression (4.1% versus 28.1%; P=0.004); Landmarking at 1 year and 1 month revealed consistent findings. Both improved survival and less progression of disease at 5 years after elective TEVAR were associated with stent graft induced false lumen thrombosis in 90.6% of cases (P