胸主动脉腔内修复术治疗慢性B型主动脉夹层中期疗效分析

Midterm outcome analysis of endovascular treatment for chronic type B aortic dissection

目的评价慢性B型主动脉夹层（chronic type B aortic dissection,c TBD）行胸主动脉腔内修复术（thoracic endovascular aortic repair,TEVAR）的安全性和可行性。方法回顾性分析2011年1月-2013年12月本院行TEVAR的25例c TBD患者临床资料。根据随访结果和影像学资料评估患者临床转归和动脉重塑情况。结果手术成功率100%,术后30 d内无死亡病例,中位随访时间28.9（26.4-35.2）个月,1年生存率100%,2年和3年生存率均为95.2%（95%CI：86.1%-100%）;支架覆盖动脉段动脉重塑较好,支架以远动脉段累积动脉扩张发生率30%-45%。结论 TEVAR治疗c TBD的成功率和早、中期生存率高,但支架以远动脉重塑水平差。行TEVAR治疗的c TBD患者,术后需密切影像学随访。

Objective To assess midterm results of endovascular stent-graft placement for chronic type B aortic dissection （cTBD） and evaluate the safety and efficacy of TEVAR in cTBD patients.Methods Clinical data about 25 patients who were treated with stent-graft implantation for cTBD in our hospital from February 2011 to December 2013 were retrospectively analyzed. The clinical outcomes and arterial remodeling of patients were evaluated based on the follow-up and image data.Results The success rate was 100%, and no patients died within 30 days. Median follow-up time was 28.9 （26.4-35.2） months. The cumulative survival rate of 1 year and 3 years were 100% and 95.2%, respectively （95%CI： 86.1%-100%）. The aortic remodeling was good in the stents recovered segment, while the cumulative aortic enlargement incidence of aortic segment distal to stent-graft was 30% - 45%.Conclusion TEVAR treatment for cTBD shows high technical success rate and high survival rate of early and middle age, but aortic remodeling of aortic segment distal to stent-graft performs bad. cTBD patients treated with TEVAR require close imaging follow-up.