{"title":"胸腔内移植术和远端裸支架治疗亚急性复杂 B 型主动脉夹层后，管腔真正扩张，但主动脉没有重塑。","authors":"I-Ming Chen, Tzu-Ting Kuo, Chun-Yang Huang, Po-Lin Chen, Chun-Che Shih","doi":"10.1097/JCMA.0000000000001132","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The effects of thoracic endovascular aneurysm repair (TEVAR) with additional distal bare metal stents (BMSs) in patients with subacute complicated type B aortic dissection (cTBAD) are unclear and are investigated in this retrospective study.</p><p><strong>Methods: </strong>The medical records of 67 patients who received TEVAR due to subacute cTBAD were reviewed. Areas of true lumen (TL) and false lumen at five levels-pulmonary artery (PA), diaphragm, renal artery (RA), middle of the infrarenal aorta, and aortic bifurcation-were measured using computed tomography before and 3, 6, and 12 months after surgery. The TL ratio (TL area/total aortic area) and total aortic area at each time point were compared between the TEVAR + BMS (n = 37) and TEVAR-only (n = 30) groups. The effects of BMS use and time were evaluated using generalized estimating equations and generalized linear regression models.</p><p><strong>Results: </strong>Baseline characteristics, remodeling types, and clinical outcomes did not differ significantly between the two groups. Postoperative TL ratios at the diaphragm and RA were significantly higher in the TEVAR + BMS group than in the TEVAR-only group ( p < 0.05). BMS use and time had significant interaction effects at the PA, diaphragm, and RA (all p < 0.05), but effects on total aortic area were not significant at any of the five parts. TL ratios at the diaphragm and RA exhibited greater improvement in the TEVAR + BMS group than in the TEVAR-only group at postoperative months 6 and 12 (all p < 0.001). Aortic diameters at all five parts were significantly smaller in the TEVAR + BMS group than in the TEVAR-only group (all p < 0.05).</p><p><strong>Conclusion: </strong>In patients with subacute cTBAD, TEVAR with BMS implantation effectively expands the TL from the thoracic aorta to the RA but neither enhances aortic remodeling nor elicits any change in total aortic area in whole dissected aorta relative to TEVAR only.</p>","PeriodicalId":94115,"journal":{"name":"Journal of the Chinese Medical Association : JCMA","volume":" ","pages":"842-853"},"PeriodicalIF":0.0000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"True lumen expansion but no aortic remodeling following thoracic endografting and distal bare stent for subacute complicated type B aortic dissection.\",\"authors\":\"I-Ming Chen, Tzu-Ting Kuo, Chun-Yang Huang, Po-Lin Chen, Chun-Che Shih\",\"doi\":\"10.1097/JCMA.0000000000001132\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The effects of thoracic endovascular aneurysm repair (TEVAR) with additional distal bare metal stents (BMSs) in patients with subacute complicated type B aortic dissection (cTBAD) are unclear and are investigated in this retrospective study.</p><p><strong>Methods: </strong>The medical records of 67 patients who received TEVAR due to subacute cTBAD were reviewed. Areas of true lumen (TL) and false lumen at five levels-pulmonary artery (PA), diaphragm, renal artery (RA), middle of the infrarenal aorta, and aortic bifurcation-were measured using computed tomography before and 3, 6, and 12 months after surgery. The TL ratio (TL area/total aortic area) and total aortic area at each time point were compared between the TEVAR + BMS (n = 37) and TEVAR-only (n = 30) groups. The effects of BMS use and time were evaluated using generalized estimating equations and generalized linear regression models.</p><p><strong>Results: </strong>Baseline characteristics, remodeling types, and clinical outcomes did not differ significantly between the two groups. Postoperative TL ratios at the diaphragm and RA were significantly higher in the TEVAR + BMS group than in the TEVAR-only group ( p < 0.05). BMS use and time had significant interaction effects at the PA, diaphragm, and RA (all p < 0.05), but effects on total aortic area were not significant at any of the five parts. TL ratios at the diaphragm and RA exhibited greater improvement in the TEVAR + BMS group than in the TEVAR-only group at postoperative months 6 and 12 (all p < 0.001). Aortic diameters at all five parts were significantly smaller in the TEVAR + BMS group than in the TEVAR-only group (all p < 0.05).</p><p><strong>Conclusion: </strong>In patients with subacute cTBAD, TEVAR with BMS implantation effectively expands the TL from the thoracic aorta to the RA but neither enhances aortic remodeling nor elicits any change in total aortic area in whole dissected aorta relative to TEVAR only.</p>\",\"PeriodicalId\":94115,\"journal\":{\"name\":\"Journal of the Chinese Medical Association : JCMA\",\"volume\":\" \",\"pages\":\"842-853\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the Chinese Medical Association : JCMA\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1097/JCMA.0000000000001132\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/7/8 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the Chinese Medical Association : JCMA","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/JCMA.0000000000001132","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/8 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景：亚急性复杂 B 型主动脉夹层（cTBAD）患者胸腔内血管动脉瘤修补术（TEVAR）附加远端裸金属支架（BMS）的效果尚不明确，本回顾性研究对其进行了调查：方法： 回顾性分析了 67 例因亚急性复杂 B 型主动脉夹层（cTBAD）而接受 TEVAR 的患者的病历。使用计算机断层扫描测量了肺动脉（PA）、膈肌、肾动脉（RA）、肾下主动脉中段和主动脉分叉等 5 个层面的真腔（TL）和假腔面积。比较了 TEVAR+BMS 组（37 人）和纯 TEVAR 组（30 人）在每个时间点的 TL 比值（TL 面积/主动脉总面积）和主动脉总面积。使用广义估计方程和广义线性回归模型评估了使用 BMS 和时间的影响：结果：两组的基线特征、重塑类型和临床结果无显著差异。TEVAR+BMS组术后膈肌和RA的TL比值明显高于单纯TEVAR组（P＜0.05）。在 PA、膈肌和 RA 处，BMS 的使用和时间具有显著的交互作用（均 p < 0.05），但在 5 个部位中，对主动脉总面积的影响均不显著。在术后第 6 个月和第 12 个月，TEVAR+BMS 组的膈肌和 RA 的 TL 比值比单纯 TEVAR 组有更大的改善（均 p <0.001）。TEVAR+BMS组所有5个部位的主动脉直径均明显小于纯TEVAR组（所有P＜0.05）：结论：在亚急性 cTBAD 患者中，植入 BMS 的 TEVAR 可有效扩展从胸主动脉到 RA 的 TL，但相对于单纯 TEVAR，既不会增强主动脉重塑，也不会引起整个剥离主动脉总面积的任何变化。
True lumen expansion but no aortic remodeling following thoracic endografting and distal bare stent for subacute complicated type B aortic dissection.
Background: The effects of thoracic endovascular aneurysm repair (TEVAR) with additional distal bare metal stents (BMSs) in patients with subacute complicated type B aortic dissection (cTBAD) are unclear and are investigated in this retrospective study.
Methods: The medical records of 67 patients who received TEVAR due to subacute cTBAD were reviewed. Areas of true lumen (TL) and false lumen at five levels-pulmonary artery (PA), diaphragm, renal artery (RA), middle of the infrarenal aorta, and aortic bifurcation-were measured using computed tomography before and 3, 6, and 12 months after surgery. The TL ratio (TL area/total aortic area) and total aortic area at each time point were compared between the TEVAR + BMS (n = 37) and TEVAR-only (n = 30) groups. The effects of BMS use and time were evaluated using generalized estimating equations and generalized linear regression models.
Results: Baseline characteristics, remodeling types, and clinical outcomes did not differ significantly between the two groups. Postoperative TL ratios at the diaphragm and RA were significantly higher in the TEVAR + BMS group than in the TEVAR-only group ( p < 0.05). BMS use and time had significant interaction effects at the PA, diaphragm, and RA (all p < 0.05), but effects on total aortic area were not significant at any of the five parts. TL ratios at the diaphragm and RA exhibited greater improvement in the TEVAR + BMS group than in the TEVAR-only group at postoperative months 6 and 12 (all p < 0.001). Aortic diameters at all five parts were significantly smaller in the TEVAR + BMS group than in the TEVAR-only group (all p < 0.05).
Conclusion: In patients with subacute cTBAD, TEVAR with BMS implantation effectively expands the TL from the thoracic aorta to the RA but neither enhances aortic remodeling nor elicits any change in total aortic area in whole dissected aorta relative to TEVAR only.
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