胸主动脉腔内修复术联合限制性裸支架治疗B型主动脉夹层对术后主动脉重塑的影响

Influence of thoracic endovascular aortic repair plus restrictive bare stent implantation for type B aortic dissection on postoperative aortic remodeling

目的:探讨胸主动脉腔内修复术(TEVAR)联合限制性裸支架(RBS)治疗胸主动脉夹层对术后主动脉重塑的影响。方法:回顾性分析2012年8月—2014年8月收治的20例B型主动脉夹层患者资料,其中11例行单纯TEVAR术(TEVAR组)与9例行TEVAR联合RBS(TEVAR+RBS组)。根据术前及术后随访期间行主动脉全长CTA数据,比较两组术后主动脉重塑相关指标。结果:两组手术技术成功率均为100%,术后无截瘫、脑卒中、主动脉破裂等并发症发生。TEVAR+RBS组中RBS与覆膜支架平均重叠了36.5 mm。与TEVAR组比较,TEVAR+RBS组术后整体真腔体积扩大率明显降低(34.9%vs.64.9%,P=0.011);支架远端面积扩大率(43.5%vs.107.3%,P=0.006)、支架远端最长径扩大率(-12.2%vs.18.5%,P=0.002)均明显降低;TEVAR组与TEVAR+RBS组术后整体假腔体积缩小率(74.8%vs.65.3%,P=0.328)、假腔内血栓化比率均无统计学差异(47.3%vs.56.8%,P=0.271)。结论:与单纯TEVAR术比较,TEVAR+RBS对胸主动脉夹层术后主动脉重塑整体改善的程度并没有优势,但可有效降低TEVAR术后支架远端真腔面积(或最长径)过度扩大,因而可能降低支架远端再发破口的发生。

Objective：To investigate the influence of thoracic endovascular aortic repair （TEVAR） combined with restrictive bare stent （RBS） implantation on postoperative aortic remodeling in treatment of aortic dissection. Methods：hTe data of 20 patients with type B aortic dissection treated from August 2012 to August 2014 wereretrospectively analyzed. Of the patients, 11 cases underwent TEVAR alone （TEVAR group）, and 9 cases received TEVAR plus RBS implantation （TEVAR＋RBS group）. According to the preoperative and postoperative follow-up CTA data, the relevant variables related to postoperative aortic remodeling were compared between the two groups of patients. Results：The operative success rate was 100%for either group, and no postoperative complications such as paraplegia, stroke, and aortic rupture occurred. The mean overlap length of RBS and covered stent was 36.5 mm in TEVAR＋RBS group. Compared with TEVAR group, the oversizing rate of entire true lumen volume （34.9%vs. 64.9%, P=0.011）, the area distal to the covered stent gratf （43.5%vs. 107.3%, P=0.006） and the longest diameter distal to the covered stent gratf （–12.2%vs. 18.5%, P=0.002） in TEVAR＋RBS group were all signiifcantly reduced. hTere was no signiifcant difference between TEVAR group and TEVAR＋RBS group in shrinkage rate of the false lumen volume （74.8%vs.65.3%, P=0.328） and the false lumen thrombosis rate （56.8%vs. 47.3%, P=0.271）. Conclusion：Compared with TEVAR alone, TEVAR combined with RBS for aortic dissection shows no superiority in improving postoperative aortic remodeling. However, it can effectively decrease the oversizing of the area （or longest diameter） of the true lumen distal to the stent, and thereby may reduce the incidence of distal stent gratf-induced new entry.