La Eun Kim, Jong Ha Park, Han Cheol Lee, Mi Ju Bae, Ji Hoon You
{"title":"急性主动脉夹层伴灌注不良综合征的血管内治疗中期临床疗效。","authors":"La Eun Kim, Jong Ha Park, Han Cheol Lee, Mi Ju Bae, Ji Hoon You","doi":"10.5758/vsi.240006","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>There is limited data on the midterm results of endovascular treatment for acute type B aortic dissection (TBAD) with malperfusion syndrome (MS), particularly in Asia. This study aimed to investigate the clinical outcomes of endovascular treatment of acute TBAD with MS.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 27 patients who underwent endovascular treatment for acute TBAD with MS.</p><p><strong>Results: </strong>Among the 27 patients with TBAD and MS, malperfusion was observed in the isolated renal (44.4%), visceral (7.4%) and iliofemoral (25.9%) arteries, as well as their combinations (22.2%). The patients underwent thoracic endovascular aortic repair (TEVAR) only (25.9%), selective stenting only in arteries affected by malperfusion (22.2%), or combined treatment with TEVAR and selective stenting (51.9%). Primary technical success was achieved in all the patients. No inhospital mortality or early death within 30 days after operation occurred. The rates of stroke, limb ischemia, acute kidney injury, and reintervention at 30 days were 7.4%, 3.7%, 25.9%, and 3.7%, respectively. The mean follow-up period was 4.3±3.1 years. During the follow-up, the rates of death, stroke, maintenance hemodialysis, aneurysmal change, and reintervention were 0%, 3.7%, 7.4%, 7.4%, and 7.4%, respectively. Two patients required reintervention due to limb ischemia and aneurysmal changes in the distal portion of the stent graft. Computed tomography scans revealed a significant increase in aortic diameters in patients who underwent selective stenting compared to those who underwent TEVAR over a 3-year period, with changes in aortic area measuring 878.9 mm<sup>2</sup> vs. 188.4 mm<sup>2</sup> at the middle of the lesion (P=0.037), 303.7 mm<sup>2</sup> vs. 22.8 mm<sup>2</sup> at the level of the celiac trunk (P=0.025), and 442.9 mm<sup>2</sup> vs. 37.3 mm<sup>2</sup> at the level of the renal artery (P=0.019).</p><p><strong>Conclusion: </strong>The endovascular treatment of acute TBAD with MS demonstrated a high primary technical success rate and promising short- and midterm clinical outcomes.</p>","PeriodicalId":52311,"journal":{"name":"Vascular Specialist International","volume":"40 ","pages":"17"},"PeriodicalIF":0.8000,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11157333/pdf/","citationCount":"0","resultStr":"{\"title\":\"Midterm Clinical Outcomes of Endovascular Treatment for Acute Aortic Dissection with Malperfusion Syndrome.\",\"authors\":\"La Eun Kim, Jong Ha Park, Han Cheol Lee, Mi Ju Bae, Ji Hoon You\",\"doi\":\"10.5758/vsi.240006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>There is limited data on the midterm results of endovascular treatment for acute type B aortic dissection (TBAD) with malperfusion syndrome (MS), particularly in Asia. This study aimed to investigate the clinical outcomes of endovascular treatment of acute TBAD with MS.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 27 patients who underwent endovascular treatment for acute TBAD with MS.</p><p><strong>Results: </strong>Among the 27 patients with TBAD and MS, malperfusion was observed in the isolated renal (44.4%), visceral (7.4%) and iliofemoral (25.9%) arteries, as well as their combinations (22.2%). The patients underwent thoracic endovascular aortic repair (TEVAR) only (25.9%), selective stenting only in arteries affected by malperfusion (22.2%), or combined treatment with TEVAR and selective stenting (51.9%). Primary technical success was achieved in all the patients. No inhospital mortality or early death within 30 days after operation occurred. The rates of stroke, limb ischemia, acute kidney injury, and reintervention at 30 days were 7.4%, 3.7%, 25.9%, and 3.7%, respectively. The mean follow-up period was 4.3±3.1 years. During the follow-up, the rates of death, stroke, maintenance hemodialysis, aneurysmal change, and reintervention were 0%, 3.7%, 7.4%, 7.4%, and 7.4%, respectively. Two patients required reintervention due to limb ischemia and aneurysmal changes in the distal portion of the stent graft. Computed tomography scans revealed a significant increase in aortic diameters in patients who underwent selective stenting compared to those who underwent TEVAR over a 3-year period, with changes in aortic area measuring 878.9 mm<sup>2</sup> vs. 188.4 mm<sup>2</sup> at the middle of the lesion (P=0.037), 303.7 mm<sup>2</sup> vs. 22.8 mm<sup>2</sup> at the level of the celiac trunk (P=0.025), and 442.9 mm<sup>2</sup> vs. 37.3 mm<sup>2</sup> at the level of the renal artery (P=0.019).</p><p><strong>Conclusion: </strong>The endovascular treatment of acute TBAD with MS demonstrated a high primary technical success rate and promising short- and midterm clinical outcomes.</p>\",\"PeriodicalId\":52311,\"journal\":{\"name\":\"Vascular Specialist International\",\"volume\":\"40 \",\"pages\":\"17\"},\"PeriodicalIF\":0.8000,\"publicationDate\":\"2024-06-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11157333/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Vascular Specialist International\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.5758/vsi.240006\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Vascular Specialist International","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5758/vsi.240006","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
摘要
目的：关于急性B型主动脉夹层（TBAD）合并灌注不良综合征（MS）的血管内治疗中期结果的数据有限，尤其是在亚洲。本研究旨在探讨急性B型主动脉夹层伴MS的血管内治疗的临床效果：我们回顾性分析了27例接受血管内治疗的急性TBAD伴MS患者：在 27 例 TBAD 和 MS 患者中，孤立肾动脉（44.4%）、内脏动脉（7.4%）和髂股动脉（25.9%）以及它们的组合（22.2%）均出现灌注不良。患者只接受了胸腔内主动脉血管修复术（TEVAR）（25.9%），只对受灌注不良影响的动脉进行了选择性支架植入术（22.2%），或接受了TEVAR和选择性支架植入术的联合治疗（51.9%）。所有患者都取得了初步技术成功。术后30天内无住院死亡或早期死亡。中风、肢体缺血、急性肾损伤和术后30天内再次介入的比例分别为7.4%、3.7%、25.9%和3.7%。平均随访时间为 4.3±3.1 年。随访期间，死亡、中风、维持性血液透析、动脉瘤病变和再次介入的比例分别为 0%、3.7%、7.4%、7.4% 和 7.4%。两名患者因肢体缺血和支架移植物远端动脉瘤变而需要再次介入治疗。计算机断层扫描显示，与接受 TEVAR 的患者相比，接受选择性支架植入术的患者主动脉直径在 3 年内显著增加，主动脉面积的变化为 878.病变中部的主动脉面积为878.9 mm2 vs. 188.4 mm2（P=0.037），腹腔干水平的主动脉面积为303.7 mm2 vs. 22.8 mm2（P=0.025），肾动脉水平的主动脉面积为442.9 mm2 vs. 37.3 mm2（P=0.019）：结论：急性TBAD合并MS的血管内治疗显示出较高的初级技术成功率和良好的短期和中期临床效果。
Midterm Clinical Outcomes of Endovascular Treatment for Acute Aortic Dissection with Malperfusion Syndrome.
Purpose: There is limited data on the midterm results of endovascular treatment for acute type B aortic dissection (TBAD) with malperfusion syndrome (MS), particularly in Asia. This study aimed to investigate the clinical outcomes of endovascular treatment of acute TBAD with MS.
Materials and methods: We retrospectively analyzed 27 patients who underwent endovascular treatment for acute TBAD with MS.
Results: Among the 27 patients with TBAD and MS, malperfusion was observed in the isolated renal (44.4%), visceral (7.4%) and iliofemoral (25.9%) arteries, as well as their combinations (22.2%). The patients underwent thoracic endovascular aortic repair (TEVAR) only (25.9%), selective stenting only in arteries affected by malperfusion (22.2%), or combined treatment with TEVAR and selective stenting (51.9%). Primary technical success was achieved in all the patients. No inhospital mortality or early death within 30 days after operation occurred. The rates of stroke, limb ischemia, acute kidney injury, and reintervention at 30 days were 7.4%, 3.7%, 25.9%, and 3.7%, respectively. The mean follow-up period was 4.3±3.1 years. During the follow-up, the rates of death, stroke, maintenance hemodialysis, aneurysmal change, and reintervention were 0%, 3.7%, 7.4%, 7.4%, and 7.4%, respectively. Two patients required reintervention due to limb ischemia and aneurysmal changes in the distal portion of the stent graft. Computed tomography scans revealed a significant increase in aortic diameters in patients who underwent selective stenting compared to those who underwent TEVAR over a 3-year period, with changes in aortic area measuring 878.9 mm2 vs. 188.4 mm2 at the middle of the lesion (P=0.037), 303.7 mm2 vs. 22.8 mm2 at the level of the celiac trunk (P=0.025), and 442.9 mm2 vs. 37.3 mm2 at the level of the renal artery (P=0.019).
Conclusion: The endovascular treatment of acute TBAD with MS demonstrated a high primary technical success rate and promising short- and midterm clinical outcomes.
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