急性主动脉夹层近端修复术后远端残余夹层的再干预:主动脉腔内全程重塑装置(AERD)的应用  

Reintervention for distal residual dissection after proximal repair of acute aortic dissection:experience of aortic endovascular remodeling device

作　　者：李雯帆 卢晨 杨鹏[1] 刘宇[1] 王海越 蒙炜[1] 肖正华[1] 胡佳[1] Li Wenfan;Lu Chen;Yang Peng;Liu Yu;Wang Haiyue;Meng Wei;Xiao Zhenghua;Hu Jia(Department of Cardiovascular Surgery,West China Hospital of Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院心脏大血管外科,成都610041

出　　处：《中华胸心血管外科杂志》2024年第6期339-344,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(81670327,81300155);四川省科技计划项目(2022YFS0358);四川大学华西医院学科卓越发展1·3·5工程新技术基金(2020HXJS015);四川大学华西医院学科卓越发展1·3·5工程临床研究孵化项目(2020HXFH043,2019HXFH027)。

摘　　要：目的总结单中心3年随访结果评估主动脉腔内全程重塑装置(AERD)的中期临床疗效。方法2019年1月至2019年6月四川大学华西医院心脏大血管外科的18例主动脉夹层近端修复术后残余夹层的患者接受了AERD治疗,对其进行术后3年随访,完成血管增强CT复查。主要结局指标为全因死亡和支架相关死亡。次要结局指标包括分支动脉通畅率、再次手术率和严重不良事件。通过形态学指标评估AERD治疗远端残余夹层的有效性。结果17例完成了术后3年随访,1例失访。随访期间无支架相关死亡及分支动脉闭塞发生,无新发严重不良事件。12例完成影像学复查,AERD术后3年患者真腔明显扩张,假腔显著缩减,真腔体积(52.39±22.32)cm^(3)对(74.34±14.64)cm^(3)(P<0.01),假腔体积(50.42±25.44)cm^(3)对(32.32±31.75)cm^(3)(P<0.01)。尤其在肾动脉下平面和肾动脉下5 cm平面,真腔最小直径[(0.96±0.30)cm对(1.41±0.21)cm,(0.83±0.22)cm对(1.65±0.16)cm,P<0.001]和面积的增加[(1.23±0.40)cm^(2)对(1.94±0.44)cm^(2),(1.27±0.66)cm^(2)对(2.50±0.46),P<0.001]、假腔直径的变小[(2.40±0.40)cm对(1.07±0.49)cm,(2.29±0.43)cm对(0.91±0.79)cm,P<0.001],差异较术前均有明显统计学意义。结论AERD治疗远端残余夹层的中期效果令人满意,促进了远端主动脉正性重塑,具有良好的安全性和有效性。Objective To analyzed the 3-year follow-up results in a single center to evaluate the mid-term clinical efficacy of aortic endovascular remodeling device(AERD).Methods From January 2019 to June 2019,18 patients with residual aortic dissection after proximal repair of acute aortic dissection were treated with AERD in our heart center of West China Hospital of Sichuan University.They were followed up for 3 years after surgery and underwent vascular enhanced CT review.The primary outcome of our study included all-cause mortality and stent-related mortality.Secondary outcome included branch patency rate,reoperation rate and the incidence of serious adverse events.Morphological measures assessed the effectiveness of AERD in treating residual distal dissection.Results 17 patients completed the 3-year follow-up,and 1 was lost to follow-up.There was no stent-related death,branch artery occlusion,or new serious adverse events.12 patients completed vascular enhanced CT review,the true lumen was significantly expanded and the false lumen was reduced considerably at 3-year follow-up,true lumen volume,(52.39±22.32)cm^(3) vs.(74.34±14.64)cm^(3)(P<0.01),false lumen volume(50.42±25.44)cm^(3) vs.(32.32±31.75)cm^(3)(P<0.01).Increased true lumen diameter and area(P<0.001)and decreased false lumen diameter(P<0.001)were significantly different from those before operation,especially in the level below the renal artery and 5 cm below the renal artery.Conclusion The mid-term effect of AERD in treating distal residual dissection is satisfactory,and it promoted positive distal aorta remodeling with safety and effectiveness.

关 键 词：急性主动脉夹层 残余夹层 主动脉腔内全程重塑装置 远端主动脉重塑 

分 类 号：R654.3[医药卫生—外科学]