急性B型主动脉夹层腔内修复术后远端裂口选择性处理的疗效分析  

Efficacy Analysis of Selective Management of the Distal Tear After Endovascular Repair for Acute Type B Aortic Dissection

作　　者：梁建豪 方青波[2] 杨建平[2] 慈红波[2] 戈小虎[2] LIANG Jianhao;FANG Qingbo;YANG Jianping(School of Medicine,Shihezi University,Shihezi,Xinjiang Uygur Autonomous Region 832000,P.R.China)

机构地区：[1]石河子大学医学院,石河子832000 [2]新疆维吾尔自治区人民医院血管外科,乌鲁木齐830000

出　　处：《临床放射学杂志》2023年第3期482-486,共5页Journal of Clinical Radiology

摘　　要：目的探讨急性B型主动脉夹层(ATBAD)胸主动脉腔内修复术(TEVAR)后选择性处理胸主动脉远端裂口的安全性和有效性。方法回顾性搜集TEVAR术后存在胸主动脉远端裂口的ATBAD患者资料,根据是否处理胸主动脉段远端裂口将其分为处理组和对照组,统计两组患者的基线资料、主动脉重塑数据和主动脉相关不良事件发生情况,总结分析选择性处理胸主动脉远端裂口的疗效。结果共纳入74例ATBAD患者,处理组38例,均封堵胸主动脉段远端裂口;对照组36例,未干预远端裂口。随访12个月后,两组患者在主动脉相关不良事件及再干预率未见明显差异(P>0.05),左锁骨下动脉和膈肌水平主动脉直径对比中,处理组重塑效果更佳(32.1 mm vs 33.1 mm,30.0 mm vs 31.7 mm,P<0.05),左肾动脉下缘水平未见明显差异(31.6 mm vs 30.9 mm,P>0.05),处理组的胸主动脉段假腔完全血栓化率高于对照组(86.9%vs 58.3%,P<0.05),腹主动脉段未见明显差异(15.8%vs 11.1%,P>0.05)。处理组随访期间出现支架源性裂口3例,对照组出现逆行A型夹层1例,均接受再干预治疗,无死亡、截瘫、内漏等事件。结论早期结果表明选择性处理急性B型主动脉夹层TEVAR术后胸主动脉远端裂口可以促进主动脉重塑,是安全有效的。Objective To investigate the safety and efficacy of selective management of distal thoracic aortic tears after thoracic endovascular aortic repair(TEVAR)for acute type B aortic dissection(ATBAD).Methods The data of ATBAD patients with distal thoracic aortic tears after TEVAR who were admitted to our center.And they were divided into treatment group and control group according to whether the distal tears of the thoracic aortic segment were treated.The baseline data,aortic remodeling data and the occurrence of aortic-related adverse events of the two groups were collected,and the efficacy of selective treatment of distal thoracic aortic tears was summarized and analyzed.Results A total of 74 patients with ATBAD were enrolled,including 58(78.4%)males and 16(21.6%)females,with an average age of 51.7±9.2 years.There were 38 cases in the treatment group,all of which blocked the distal tear of the thoracic aortic segment,and 36 cases in the control group did not intervene in the distal tear.After 12 months of follow-up,there was no significant difference in the aortic-related adverse events and re-intervention rates between the two groups(P>0.05).In the comparison of aortic diameters at the level of the left subclavian artery and the diaphragm,the treatment group had better remodeling effect(32.1mm vs 33.1mm,30.0mm vs 31.7mm,P<0.05),there was no significant difference in the level of the inferior border of the left renal artery(31.6 mm vs 30.9 mm,P>0.05),and the complete thrombosis rate of the false lumen of the thoracic aorta in the treatment group was higher than that in the control group(86.9%vs 58.3%,P<0.05),and there was no significant difference in the abdominal aortic segment(15.8%vs 11.1%,P>0.05).During the follow-up period,there were 3 cases of stent-induced new entry tear(SINE)in the treatment group,and 1 case of retrograde type A aortic dissection(RTAD)in the control group,all of which received re-intervention treatment,and there was no death,paraplegia,endoleak and other events.Conclusion Early results sugg

关 键 词：主动脉夹层 胸主动脉腔内修复术 远端裂口 

分 类 号：R654.3[医药卫生—外科学]