Favorable Remodeling After TEVAR in Uncomplicated Acute and Subacute Type B Aortic Dissection in Comparison to Conservative Treatment: A Midterm Analysis.

IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE
Journal of Endovascular Therapy Pub Date : 2024-10-01 Epub Date: 2023-03-08 DOI:10.1177/15266028231158971
Wael Ahmad, Jan Brunkwall, Alexander C Bunck, Bernhard Dorweiler, Spyridon Mylonas
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引用次数: 0

Abstract

Purpose: The purpose of the study was to evaluate the midterm and long-term outcomes of patients who underwent thoracic endovascular aortic repair (TEVAR) procedure to treat an uncomplicated acute and subacute type B aortic dissection (uATBAD) with high risk for subsequent aortic complications compared with the group of patients who received a conservative treatment protocol during the same period.

Materials and methods: Between 2008 and 2019, 35 patients who had TEVAR due to uATBAD and those with conservative procedure (n=18) were included in a retrospective analysis and follow-up study. The primary endpoints were false lumen thrombosis/perfusion, true lumen diameter, and aortic dilatation. The aortic-related mortality, reintervention, and long-term survival were the secondary endpoints.

Results: In the study period, 53 patients (22 females) with a mean age of 61.1±13 years were included. No 30-day and in-hospital mortality was recorded. Permanent neurological deficits occurred in 2 patients (5.7%). In the TEVAR group (n=35) and in a median follow-up period of 34 months, a significant reduction of maximum aortic and false lumen diameter as well as a significant increase of true lumen diameter were detected (p<0.001 each). Complete false lumen thrombosis increased from 6% preoperatively to 60% at follow-up. The median difference in aortic, false lumen, and true lumen diameter was -5 mm (interquartile range [IQR]=-28 to 8 mm), -11 mm (IQR=-53 to 10 mm), and 7 mm (IQR=-13 to 17 mm), respectively. In 3 patients (8.6%), a reintervention was needed. Two patients (1 aortic-related) died during follow-up. The estimated survival according to Kaplan-Meyer analysis was 94.1% after 3 years and 87.5% after 5 years. Similar to the TEVAR group, no 30-day or in-hospital mortality was recorded in the conservative group. During follow-up, 2 patients died and 5 patients underwent conversion-TEVAR (28%). In a median follow-up period of 26 months (range=150), a significant increase of maximum aortic diameter (p=0.006) and a tendency to augmentation of the false lumen (p=0.06) were noted. No significant reduction of the true lumen was seen.

Conclusions: Thoracic endovascular aortic repair in patients at high risk of subsequent aortic complications in uncomplicated acute and subacute type B aortic dissection is safe and is associated with favorable midterm outcomes regarding aortic remodeling.

Clinical impact: In a retrospective, single center analysis of prospectively collected data with follow-up, we compared 35 patients with high-risk features who recieved TEVAR in acute and sub-acute uncomplicated type B aortic dissection to a control-group (n=18). The TEVAR group showed a significant positive remoduling (reduction of max. aortic and false lumen diameter and increase of true lumen diameter (p<0.001 each)) during follow-up with an estimated survival of 94.1% after 3 years and 87.5% after 5 years.

与保守治疗相比,无并发症的急性和亚急性 B 型主动脉夹层经 TEVAR 后重塑效果更佳:中期分析。
目的:该研究旨在评估接受胸腔内血管主动脉修复术(TEVAR)治疗无并发症的急性和亚急性B型主动脉夹层(uATBAD)且后续主动脉并发症风险高的患者与同期接受保守治疗方案的患者组的中期和长期疗效比较:2008年至2019年期间,35例因uATBAD而接受TEVAR的患者和接受保守治疗的患者(18例)被纳入回顾性分析和随访研究。主要终点是假腔血栓/灌注、真腔直径和主动脉扩张。主动脉相关死亡率、再次介入治疗和长期存活率为次要终点:研究期间共纳入 53 名患者(22 名女性),平均年龄为 61.1±13 岁。无30天和住院期间死亡记录。2例患者(5.7%)出现永久性神经功能缺损。在TEVAR组(35人)中,中位随访时间为34个月,发现主动脉最大直径和假腔直径显著缩小,真腔直径显著增加(p结论:对无并发症的急性和亚急性 B 型主动脉夹层患者进行胸腔内血管主动脉修补术是安全的,而且与主动脉重塑的良好中期结果相关:在一项对前瞻性收集的随访数据进行的单中心回顾性分析中,我们将急性和亚急性无并发症B型主动脉夹层中接受TEVAR的35例高风险患者与对照组(18例)进行了比较。TEVAR 组的重塑效果显著(主动脉和假腔最大直径减小,真腔直径增大(P<0.05))。
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来源期刊
CiteScore
5.30
自引率
15.40%
发文量
203
审稿时长
6-12 weeks
期刊介绍: The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.
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