Abstract:Objective: To compare the therapeutic effects of thoracic endovascular aortic repair (TEVAR) on patients with Stanford B-type aortic dissection (AD) in different stages and the effect on aortic remodeling shape. Methods: A total of 96 patients with Stanford B-type AD treated with TEVAR were enrolled in the study, including 62 patients in the chronic phase (chronic phase group) and 34 patients in the subacute phase (subacute phase group). The clinical data, diameters of true and false lumen before and after operation, complete absorption rate of thrombus in false lumen at the stent segment, aortic remodeling rate, reoperation rate and prognosis were compared between the two groups. Results: The rates of true lumen collapse and tumor-like expansion in the chronic phase group were significantly higher than those in the subacute phase group (P<0.05); and the rate of complete thrombosis was significantly lower than the subacute phase group (P<0.05). The increase in diameter of the true lumen and reduction in diameter of the false lumen in the subacute phase group were significantly greater than those in the chronic phase group (P<0.05). The complete absorption rate of thrombus in false lumen at the stent segment after operation and aortic remodeling rate in the subacute phase group were significantly higher than those in the chronic phase group (P<0.05); and the reoperation rate was significantly lower than the chronic phase group (P<0.05). Follow-up found that the survival rate of the subacute phase group was significantly higher than that of the chronic phase group (χ2=4.810, P=0.028). Conclusion: Compared with chronic Stanford B ad, subacute phase is more stable, and the recovery of true and false lumen, thrombus complete absorption rate and aortic remodeling after TEVAR are better, which can obtain better prognosis.
李剑, 童希文, 汪坤, 廖进勇. TEVAR术对不同期Stanford B型主动脉夹层患者疗效及主动脉重塑形态的影响[J]. 河北医学, 2020, 26(10): 1685-1689.
LI Jian, TONG Xiwen, WANG Kun, et al. Effect of TEVAR on Aortic Remodeling in Patients with Stanford Type B Aortic Dissection at Different Stages. HeBei Med, 2020, 26(10): 1685-1689.
[1] Liu Z , Zhang Y , Liu C , et al. Treatment of serious complications following endovascular aortic repair for type B thoracic aortic dissection[J].Int Med Res, 2017, 45(5):1574~1584. [2] Qin YL , Wang F , Li TX , et al. Endovascular repair compared with medical management of patients with uncomplicated type B acute aortic dissection[J].Am Coll Cardiol, 2016, 67(24):2835~2842. [3] Rylski B , Hoffmann I , Beyersdorf F , et al. Acute aortic dissection type a: age-related management and outcomes reported in the german registry for acute aortic dissection type A (GERAADA) of over 2000 patients[J]. Ann Surg, 2014, 259(3):598~604. [4] 洪翔,史振宇,符伟国,等.StanfordB型慢性主动脉夹层腔内修复术后血管重塑及其相关因素分析[J].中华普通外科杂志,2016,31(8):628~631. [5] Huang W , Yang F , Luo J , et al. Outcomes and Morphologic Changes of Immediate Type Ia Endoleak following Endovascular Repair of Acute Type B Aortic Dissection[J]. Ann Vasc Surg, 2015, 29(2):174~182. [6] 韩磊,万珊杉,王家平,等.不同期Stanford B型胸主动脉夹层腔内修复术后疗效及主动脉重塑临床研究[J].介入放射学杂志,2016,25(11):958~961. [7] Zhang MH , Du X, Guo W, et al. Early and midterm outcomes of thoracic endovascular aortic repair (TEVAR) for acute and chronic complicated type B aortic dissection[J]. MEDICINE,2017,96(28):e7183. [8] Conrad MF , Carvalho S , Ergul E , et al. Late aortic remodeling persists in the stented segment after endovascular repair of acute complicated type B aortic dissection[J].Vasc Surg, 2015, 62(3):600~605. [9] 林长泼,岳嘉宁,符伟国.非复杂性Stanford B型主动脉夹层腔内修复术的时机选择[J].中华外科杂志,2018,56(10):741~744.