The new indication of TEVAR for uncomplicated type B aortic dissection.
The new indication of TEVAR for uncomplicated type B aortic dissection.
复制标题
TEVAR治疗单纯性B型主动脉夹层的新适应症
DOI：
10.1097/md.0000000000003919
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发表时间：
2016-06
期刊：
影响因子：
1.6
通讯作者：
Jing Z
中科院分区：
文献类型：
--
作者：
Song C;Lu Q;Zhou J;Yu G;Feng X;Zhao Z;Bao J;Feng R;Jing Z
B型主动脉夹层的经典治疗指征是药物治疗或开放手术，相对稳定、无并发症的B型主动脉夹层推荐药物治疗。随着血管内修复技术的进步和疾病进展的潜在风险，现在有必要根据形态特征和时间窗来评估修订无并发症的B型主动脉夹层的治疗选择的要求。对1992~2015年间252例无并发症的B型主动脉夹层患者的临床资料进行回顾性分析。其中117例患者接受药物治疗，135例患者接受血管内修复。血管内治疗组60个月生存率高于药物治疗组(92.3%vs67.6%)。根据形态学评价，内脏动脉受累和假腔/真腔比大于0.7是单纯内科治疗的强烈危险因素。与那些在症状出现后14天内接受血管内修复的患者相比，慢性期患者的手术时间和失血量都有所增加。随着主动脉重塑技术的改进，腔内修复术已被证明可以提高无并发症的主动脉夹层患者的长期存活率。考虑到死亡的潜在风险，我们建议内脏动脉受累且假腔/真腔比大于0.7的患者应积极接受血管内修复。此外，慢性期延迟腔内修复并不能改善无并发症的B型主动脉夹层的长期预后。
AbstractThe classical therapeutic indication for type B aortic dissection is based on either medication or open surgery; medication therapy is recommended for relatively stable uncomplicated type B aortic dissection. With improvements in endovascular repair and the potential risk of disease progression, it is now necessary to evaluate the requirement for revision of the therapeutic choice of uncomplicated type B aortic dissection based on morphological features and time window. Data from 252 patients diagnosed as uncomplicated type B aortic dissection from 1992 to 2015 were analyzed retrospectively. Among these cases, 117 patients received medication therapy and 135 patients underwent endovascular repair. The 60-month survival rate in the endovascular group was higher than that in the medication group (92.3% vs 67.6%). According to the morphological evaluation, visceral artery involvement and false/true lumen ratios over 0.7 were strong risk factors for medical treatment alone. Increased surgical time and blood loss were found in patients treated in the chronic phase, compared with those who underwent endovascular repair within 14 days of the onset of symptoms. With improvements in aortic remodeling techniques, endovascular repair has been shown to improve long-term survival rates of patients with uncomplicated aortic dissection. Considering the potential risk of death, we recommend that patients with visceral artery involvement and a false/true lumen ratio over 0.7 should receive endovascular repair aggressively. Furthermore, delayed endovascular repair in the chronic phase does not improve the long-term outcome of uncomplicated type B aortic dissection.