Stanford B型主动脉夹层假腔供血动脉分支对腔内治疗后假腔重塑的影响

The impact of the feeding-artery branch of the falselumen on the remodeling of false cavity in Stanford B aortic dissection after endovascular repair

目的探讨胸主动脉腔内修复术(TEVAR)治疗Stanford B型主动脉夹层后,腹主动脉假腔供血动脉分支对远端假腔重塑的影响。方法单中心回顾性队列研究2005年8月至2018年8月东南大学附属中大医院采用TEVAR术治疗的56例急性和慢性Stanford B型主动脉夹层患者。通过CTA随访资料观察记录主动脉腹段假腔内血栓形成、腹主动脉内脏分支供血类型。结果56例患者腹主动脉分支真腔供血以假腔完全血栓形成和血栓吸收为主。腹主动脉假腔参与分支供血,包括双腔供血、完全假腔供血,假腔以部分血栓形成为主,同时有假腔通畅情况。有假腔参与分支供血合并有更多内膜破口,与假腔血栓形成呈负相关。结论主动脉夹层TEVAR术后腹主动脉假腔供血可影响假腔血栓形成。假腔供血分支可能是假腔部分血栓形成或通畅的危险因素。

Objective To discuss the impact of the feeding-artery branch of the false lumen on the remodeling of false cavity in Stanford B aortic dissection after thoracic endovascular aortic repair(TEVAR).Methods Single-center retrospective cohort study was conducted in 56 patients with acute or chronic Stanford B aortic dissection,who received TEVAR at the Affiliated Zhongda Hospital of Southeast University of China during the period from August 2005 to August 2018.Follow-up CT angiograpy(CTA)materials were used to observe the thrombosis in the false lumen of the aortic abdominal segment as well as the types of blood supply of the visceral branches of the abdominal aorta.Results In the 56 patients,the visceral branches received blood supply from the true lumen when completely thrombosis or thrombus absorption was observed in the false lumen.The abdominal aortic false lumen was involved in the blood supply of visceral branches,including blood supply from double-lumen and blood supply only from false lumen.Partial thrombosis in the false lumen was mainly seen,at the same time the false lumen was patency.The involvement of false lumen in the blood supply of visceral branches could combined with more intimal tears,which was negatively correlated with false lumen thrombosis.Conclusion The involvement of false lumen in the blood supply of visceral branches can affect the thrombosis in the false lumen in patients with Stanford B aortic dissection after TEVAR,and it may be a risk factor for the partial thrombosis or obstruction in the false lumen.(J Intervent Radiol,2020,29:1039-1042)