Long Term Outcomes of Endovascular Treatment for Retrograde Ascending Aortic Dissection.

IF 5.7 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

European Journal of Vascular and Endovascular Surgery Pub Date : 2025-03-04 DOI:10.1016/j.ejvs.2025.02.041

Gui-Yan Peng, Mian Wang, Chen Yao, Zi-Lun Li, Ri-Dong Wu, Zhu-Hao Li, Shen-Ming Wang, Guang-Qi Chang

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引用次数: 0

Abstract

Objective: The optimal treatment for retrograde ascending aortic dissection (rAAD) remains unclear. In this study, the long term clinical outcomes of endovascular treatment for rAAD were retrospectively investigated, and haemodynamic remodelling of the ascending aorta was analysed.

Methods: This retrospective, single centre study analysed clinical data of rAAD cases treated with endovascular therapy from 2001 - 2020. Endpoints included aortic related mortality and re-intervention. Computational fluid dynamics (CFD) models were established to compare haemodynamic changes after endovascular repair.

Results: A total of 85 patients with rAAD (mean age 52.8 ± 11.4 years, range 29.0 - 79.0 years) underwent thoracic endovascular aortic repair (TEVAR). Technical success was achieved in 73 patients (86%). In hospital death occurred in one patient (1%). During the 75 month median follow up period (interquartile range 54, 101 months), the all cause mortality was 7% (6/84, including two aorta related deaths). Overall survival rates for one, five, and ten years were 98.8%, 92.7%, and 88.6%, respectively. Sixteen aorta related adverse events were observed in 15 patients during follow up, including two proximal stent graft induced new entries (SINEs), two distal SINEs, and 12 primary endoleaks into the false lumen. Secondary endoleak was not observed. The free from aortic related event rates for one, five, and ten years were 77.3%, 74.3%, and 71.5%, respectively. Complete thrombosis or disappearance of the false lumen in the ascending aorta was observed in all cases. The true lumen diameter of the ascending aorta increased statistically significantly from 31.8 ± 5.2 mm (range 15.8 - 40.8 mm) to 35.4 ± 3.5 mm (range 28.3 - 44.0 mm) (p<.001) at the last follow up. CFD analysis showed that the median wall shear stress in the ascending aorta statistically significantly decreased from 16.4 Pa to 12.4 Pa (p= .006).

Conclusion: Encouraging short and long term outcomes were demonstrated using TEVAR for rAAD suggesting that it may represent a treatment alternative to open repair in selected cases.

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血管内治疗逆行升主动脉夹层的远期疗效。

目的：逆行性升主动脉夹层（rAAD）的最佳治疗方法尚不清楚。在本研究中，回顾性研究了血管内治疗rAAD的长期临床结果，并分析了升主动脉的血流动力学重构。方法：回顾性、单中心研究分析2001 - 2020年rAAD患者血管内治疗的临床资料。终点包括主动脉相关死亡率和再干预。建立计算流体动力学（CFD）模型，比较血管内修复后血流动力学的变化。结果：共有85例rAAD患者（平均年龄52.8±11.4岁，范围29.0 ~ 79.0岁）接受了胸廓血管内主动脉修复术（TEVAR）。73例患者（86%）获得技术成功。院内死亡1例（1%）。在75个月的中位随访期间（四分位数范围54 ~ 101个月），全因死亡率为7%（6/84，包括2例主动脉相关死亡）。1年、5年和10年的总生存率分别为98.8%、92.7%和88.6%。在随访期间，15例患者观察到16例主动脉相关不良事件，包括2例近端支架移植诱导的新窦（sin）， 2例远端窦，12例原发性假腔内漏。未观察到继发性内漏。1年、5年和10年无主动脉相关事件发生率分别为77.3%、74.3%和71.5%。所有病例均见升主动脉假腔完全血栓形成或消失。升主动脉真腔直径从31.8±5.2 mm（范围15.8 - 40.8 mm）增加到35.4±3.5 mm（范围28.3 - 44.0 mm）具有统计学意义。结论：TEVAR治疗rAAD的短期和长期结果令人鼓舞，表明在某些病例中，它可能是开放式修复的一种治疗选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Vascular and Endovascular Surgery 医学-外科

CiteScore

6.80

自引率

15.80%

发文量

471

审稿时长

66 days

期刊介绍： The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles. Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.