主动脉腔内全程重塑装置(AERD)治疗Stanford B型主动脉夹层术后远端残余夹层临床效果

Clinical efficacy of AERD in the treatment of residual aortic dissection on Stanford type B aortic dissection patients after endovascular repair

目的评估主动脉腔内全程重塑装置(aortic endovascular remodeling device,AERD)在Stanford B型主动脉夹层术后远端残余夹层治疗中的安全性和有效性。方法采用前瞻性队列研究设计,根据入排标准,纳入2022年1月至2023年12月,共60例Stanford B型主动脉夹层胸主动脉腔内修复术(TEVAR)术后患者,利用AERD进行治疗,收集术前术后CTA影像资料,采用计算机三维重建流体力学进行分析,评估术后远端主动脉重塑情况。结果术后30天内无主要不良事件发生,无与主动脉夹层相关死亡。术后短期结果显示,应用AERD治疗Stanford B型主动脉夹层术后远端残余夹层是安全的。AERD治疗明显增加夹层段真腔体积,增幅达到88.44%,同时AERD治疗明显减少夹层段假腔体积,减幅达到61.04%,效果显著。AERD治疗除对支架远端主动脉真腔最长径和肠系膜上动脉上缘主动脉真腔最长径无明显影响外,相比于主动脉真腔最长径的变化,主动脉真腔最短径的变化更为显著,支架远端主动脉真腔最短径增幅32.29%,主动脉短径最窄处真腔最短径增幅204.15%,肠系膜上动脉上缘主动脉真腔最短径增幅80.76%,肾动脉下缘主动脉真腔最短径增幅115.26%,左髂动脉开口处真腔最短径增幅152.01%,右髂动脉开口处真腔最短径增幅144.21%,AERD显著促进Stanford B型主动脉夹层术后远端主动脉良性重塑。结论AERD在Stanford B型主动脉夹层术后远端残余夹层治疗中安全有效,术后早期就能促进真腔扩张、假腔缩减,促进Stanford B型主动脉夹层TEVAR术后主动脉远端良性重塑。

Objective Evaluate the safety and efficacy of aortic endovascular remodeling device(AERD)in the treatment of residual aortic dissection on Stanford type B aortic dissection patients after endovascular repair.Methods Adopting a prospective cohort study design,according to the inclusion and exclusion criteria,a total number of 60 patients with Stanford B-type aortic dissection after TEVAR surgery from January 2022 to December 2023 were included.Collecting CTA imaging data of patients before and after endovascular treatment with AERD and using computer 3D reconstruction fluid dynamics to evaluate distal aortic remodeling.Results The incidence of major adverse events and mortality rate associated with aortic dissection within 30 days were 0 after endovascular treatment with AERD.In the short term,AERD was safe for the treatment of residual aortic dissection on Stanford type B aortic dissection patients after endovascular repair.Endovascular treatment with AERD significantly increased the volume of the true lumen of the aorta in the dissection segment,with an increase of 88.44%.At the same time,endovascular treatment with AERD significantly reduced the volume of the false lumen of the aorta in the dissection segment,with a decrease of 61.04%.Endovascular treatment with AERD has no significant effect on the longest true lumen diameter of distal aorta of stent and upper margin aorta of superior mesenteric artery.Comparing to the longest diameter of the true lumen of the aorta,the change in the shortest diameter of the true lumen of the aorta is more significant,with the shortest diameter of true lumen of distal aortic of the stent increasing by 32.29%,the shortest diameter of true lumen of the narrowest part of the aorta increasing by 204.15%,the shortest diameter of true lumen of the upper margin aorta of superior mesenteric artery increasing by 80.76%,the shortest diameter of true lumen of the lower edge aorta of the renal artery increasing by 115.26%,the shortest diameter of the opening of the left iliac artery increasing by 152.01%,and the shortest diameter of opening of the right iliac artery increasing by144.21%.Conclusion AERD is safe and effective in the treatment of residual aortic dissection on Stanford type B aortic dissection patients after endovascular repair.Endovascular treatment with AERD promotes true lumen dilation and false lumen reduction in the early postoperative stage and promotes benign remodeling of the distal aorta after TEVAR surgery.