急性B型主动脉夹层分类差异对腔内修复术疗效及安全性的影响
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摘要
目的探讨急性B型主动脉夹层分类差异对体外开窗腔内修复术(thoracic endovascular repair,TEVAR)的疗效及安全性的影响。方法选取我院2013年3月—2015年3月收治的复杂型急性B型主动脉夹层病人37例设为复杂组,将同期非复杂型急性B型主动脉夹层病人48例设为非复杂组,均采用TEVAR术治疗。比较两组30 d死亡率、围术期并发症发生率、二次干预率、动脉扩张率、假腔消失率、手术前后最大动脉直径水平及随访生存率等。结果两组30 d死亡率、围术期并发症发生率、二次干预率、动脉扩张率及假腔消失率比较差异无统计学意义(P>0.05);复杂组术后6个月和12个月最大动脉直径均显著高于术前(P<0.05);且复杂组术后同一时间点最大动脉直径均显著高于非复杂组(P<0.05);非复杂组手术前后最大动脉直径比较差异无统计学意义(P>0.05);同时两组随访生存率比较差异无统计学意义(P>0.05)。结论 EVAR治疗复杂型和非复杂型急性B型主动脉夹层在围术期并发症风险和随访生存率方面效果较为接近;但其用于非复杂型急性B型主动脉夹层病人治疗更有助于促进动脉管腔重塑。
Objective To investigate the clinical efficacy and safety of different types of acute type B aortic dissection(ATBAD) undergoing thoracic endovascular repair(TEVAR).Methods Thirty-seven patients with complicated ATBAD from March 2013 to March 2015 were chosen as group A,and 48 patients with non-complicated ATBAD were as group B.The patients underwent TEVAR.The 30-day mortality,the incidence of perioperative complication,secondary intervention rate,arterial dilatation rate,and false lumen disappearance rate,and maximum arterial diameter before and after surgery,as well as survival rate of follow-up were compared between the two groups.Results There was no significant difference in the 30-day mortality,the incidence of perioperative complication,arterial dilatation rate,false lumen disappearance rate between two groups(P>0.05).The maximum arterial diameters at 6 and 12 months after surgery were significantly higher than that of preoperation(P<0.05),which was significantly higher in group A at the same time point than that in group B(P<0.05).There was no significant difference in the maximum arterial diameter before and after surgery in group B(P>0.05).There was no significant difference in the survival rate with follow-up between two groups(P>0.05).Conclusion TEVAR for different types of ATBAD is similar in the risk of perioperative complications and follow-up survival rate.TEVAR is more helpful to promote arterial lumen remodeling in patients with non-complicated ATBAD.
Objective To investigate the clinical efficacy and safety of different types of acute type B aortic dissection(ATBAD) undergoing thoracic endovascular repair(TEVAR).Methods Thirty-seven patients with complicated ATBAD from March 2013 to March 2015 were chosen as group A,and 48 patients with non-complicated ATBAD were as group B.The patients underwent TEVAR.The 30-day mortality,the incidence of perioperative complication,secondary intervention rate,arterial dilatation rate,and false lumen disappearance rate,and maximum arterial diameter before and after surgery,as well as survival rate of follow-up were compared between the two groups.Results There was no significant difference in the 30-day mortality,the incidence of perioperative complication,arterial dilatation rate,false lumen disappearance rate between two groups(P>0.05).The maximum arterial diameters at 6 and 12 months after surgery were significantly higher than that of preoperation(P<0.05),which was significantly higher in group A at the same time point than that in group B(P<0.05).There was no significant difference in the maximum arterial diameter before and after surgery in group B(P>0.05).There was no significant difference in the survival rate with follow-up between two groups(P>0.05).Conclusion TEVAR for different types of ATBAD is similar in the risk of perioperative complications and follow-up survival rate.TEVAR is more helpful to promote arterial lumen remodeling in patients with non-complicated ATBAD.
引文
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[14] SHAH T R,ROCKMAN C B,ADELMAN M A,et al.Nationwide comparative impact of thoracic endovascular aortic repair of acute uncomplicated type B aortic dissections [J].Vasc Endovascular Surg,2014,48(3):230-233.
[15] LI Y,ZHANG T,GUO W,et al.Endovascular chimney technique for juxtarenal abdominal aortic aneurysm:a systematic review using pooled analysis and meta-analysis [J].Ann Vasc Surg,2015,29(6):1141-1150.
[16] PREVENTZA O,MOHAMMED S,CHEONG B Y,et al.Endovascular therapy in patients with genetically triggered thoracic aortic disease:applications and short- and mid-term outcomes [J].Eur J Cardiothorac Surg,2014,46(2):248-253.
[17] ROGERS A M,HERMANN L K,BOOHER A M,et al.Sensitivity of the aortic dissection detection risk score,a novel guideline-based tool for identification of acute aortic dissection at initial presentation clinical perspective [J].Circulation,2011,123(20):2213-2218.
[18] FUNAKI B.Chronic complicated aortic dissection [J].J Vasc Interv Radiol,2013,24(10):1460-1461.
[19] NIENABER C A,KISCHE S,ROUSSEAU H,et al.Endovascular repair of type B aortic dissection:long-term results of the randomized investigation of stent grafts in aortic dissection trial [J].Circ Cardiovasc Interv,2013,6(4):407-416.
[20] TOLENAAR J L,VAN BOGERIJEN G H,EAGLE K A,et al.Update in the management of aortic dissection [J].Curr Treat Options Cardiovasc Med,2013,15(2):200-213.
[21] SCALI S T,FEEZOR R J,CHANG C K,et al.Efficacy of thoracic endovascular stent repair for chronic type B aortic dissection with aneurysmal degeneration [J].J Vasc Surg,2013,58(1):10-17.
[22] DEMIRCAN A,AKSAY E,ERGIN M,et al.Painless aortic dissection presenting with acute ischaemic stroke and multiple organ failure [J].Emerg Med Australas,2011,23(2):215-216.
[23] ANDERSEN N D,KEENAN J E,GANAPATHI A M,et al.Current management and outcome of chronic type B aortic dissection:results with open and endovascular repair since the advent of thoracic endografting [J].Ann Cardiothorac Surg,2014,3(3):264-274.
[24] BUNGER C M,KISCHE S,LIEBOLD A,et al.Hybrid aortic arch repair for complicated type B aortic dissection [J].J Vasc Surg,2013,58(6):1490-1496.
[25] JIA X,GUO W,LI T X,et al.The results of stent graft versus medication therapy for chronic type B dissection [J].J Vasc Surg,2013,57(2):406-414.
[2] WHITE R A,MILLER D C,CRIADO F J,et al.Report on the results of thoracic endovascular aortic repair for acute,complicated,type B aortic dissection at 30 days and 1 year from a multidisciplinary subcommittee of the Society for Vascular Surgery Outcomes Committee [J].J Vasc Surg,2011,53(4):1082-1090.
[3] WEIGANG E,PARKER J A,CZERNY M,et al.Should intentional endovascular stent-graft coverage of the left subclavian artery be preceded by prophylactic revascularisation?[J].Eur J Cardiothorac Surg,2011,40(4):858-868.
[4] FATTORI R,CAO P,DE RANGO P,et al.Interdisciplinary expert consensus document on management of type B aortic dissection [J].J Am Coll Cardiol,2013,61(16):1661-1678.
[5] SHU C,HE H,LI Q M,et al.Endovascular repair of complicated acute type -B aortic dissection with stentgraft:early and mid-term results [J].Eur J Vasc Endovasc Surg,2011,42(4):448-453.
[6] KAI Y,HAMADA J,MORIOKa M,et al.Dissecting aneurysms of the vertebral artery-angiographic patterns at the dissecting site on balloon test occlusion [J].Neuroradiology,2012,54(8):857-862.
[7] NAOUM J J,REARDON M J,DAVIES M G.Changing paradigm in endovascular treatment of descending thoracic aortic dissections [J].Methodist Debakey Cardiovasc J,2011,7(3):25-27.
[8] DUMFARTH J,MICHEL M,SCHMIDLI J,et al.Mechanisms of failure and outcome of secondary surgical interventions after thoracic endovascular aortic repair(TEVAR)[J].Ann Thorac Surg,2011,91(4):1141-1146.
[9] HIGASHI R,MATSUMURA Y,YAMAKI F.A single stage hybrid repair of a complicated acute type B dissection with aortic arch involvement [J].Ann Vasc Dis,2014,7(7):141-144.
[10] NOZDRZYKOWSKI M,ETZ C D,LUEHR M,et al.Optimal treatment for patients with chronic Stanford type B aortic dissection:endovascularly,surgically or both?[J].Eur J Cardiothorac Surg,2013,44(3):e165-e174.
[11] GRABENWOGER M,ALFONSO F,BACHET J,et al.Thoracic Endovascular Aortic Repair( TEVAR) for the treatment of aortic diseases:a position statement from the European Association for Cardio -Thoracic Surgery(EACTS) and the European Society of Cardiology(ESC),in collaboration with the European Association of Percutaneous Cardiovascular Interventions(EAPCI) [J].Eur Heart J,2012,33(13):1558-1563.
[12] MITSUOKA M,INOUE N,MORI S,et al.Renal dysfunction on admission as a predictor for in-hospital mortality of patients with stanford type B acute aortic dissection [J].Ann Vasc Dis,2013,6(3):624-630.
[13] HANNA J M,ANDERSEN N D,GANAPATHI A M,et al.Five-year results for endovascular repair of acute complicated type B aortic dissection [J].J Vasc Surg,2014,59(1):96-106.
[14] SHAH T R,ROCKMAN C B,ADELMAN M A,et al.Nationwide comparative impact of thoracic endovascular aortic repair of acute uncomplicated type B aortic dissections [J].Vasc Endovascular Surg,2014,48(3):230-233.
[15] LI Y,ZHANG T,GUO W,et al.Endovascular chimney technique for juxtarenal abdominal aortic aneurysm:a systematic review using pooled analysis and meta-analysis [J].Ann Vasc Surg,2015,29(6):1141-1150.
[16] PREVENTZA O,MOHAMMED S,CHEONG B Y,et al.Endovascular therapy in patients with genetically triggered thoracic aortic disease:applications and short- and mid-term outcomes [J].Eur J Cardiothorac Surg,2014,46(2):248-253.
[17] ROGERS A M,HERMANN L K,BOOHER A M,et al.Sensitivity of the aortic dissection detection risk score,a novel guideline-based tool for identification of acute aortic dissection at initial presentation clinical perspective [J].Circulation,2011,123(20):2213-2218.
[18] FUNAKI B.Chronic complicated aortic dissection [J].J Vasc Interv Radiol,2013,24(10):1460-1461.
[19] NIENABER C A,KISCHE S,ROUSSEAU H,et al.Endovascular repair of type B aortic dissection:long-term results of the randomized investigation of stent grafts in aortic dissection trial [J].Circ Cardiovasc Interv,2013,6(4):407-416.
[20] TOLENAAR J L,VAN BOGERIJEN G H,EAGLE K A,et al.Update in the management of aortic dissection [J].Curr Treat Options Cardiovasc Med,2013,15(2):200-213.
[21] SCALI S T,FEEZOR R J,CHANG C K,et al.Efficacy of thoracic endovascular stent repair for chronic type B aortic dissection with aneurysmal degeneration [J].J Vasc Surg,2013,58(1):10-17.
[22] DEMIRCAN A,AKSAY E,ERGIN M,et al.Painless aortic dissection presenting with acute ischaemic stroke and multiple organ failure [J].Emerg Med Australas,2011,23(2):215-216.
[23] ANDERSEN N D,KEENAN J E,GANAPATHI A M,et al.Current management and outcome of chronic type B aortic dissection:results with open and endovascular repair since the advent of thoracic endografting [J].Ann Cardiothorac Surg,2014,3(3):264-274.
[24] BUNGER C M,KISCHE S,LIEBOLD A,et al.Hybrid aortic arch repair for complicated type B aortic dissection [J].J Vasc Surg,2013,58(6):1490-1496.
[25] JIA X,GUO W,LI T X,et al.The results of stent graft versus medication therapy for chronic type B dissection [J].J Vasc Surg,2013,57(2):406-414.