Aortic remodelling and late outcomes following thoracic endovascular repair with a bare-metal stent distal extension among patients with complicated type-B aortic dissection.

IF 1.6 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Interactive cardiovascular and thoracic surgery Pub Date : 2022-10-10 DOI:10.1093/icvts/ivac244
Isaac Wamala, Mir Timo Zadegh Nazari-Shafti, Roland Heck, Adam Penkalla, Matteo Montagner, Steven J Staffa, Volkmar Falk, Semih Buz
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引用次数: 2

Abstract

Objectives: The goal of this study was to describe the factors affecting mid and late aortic remodelling following thoracic endovascular aortic repair with the PETTICOAT (Provisional Extension To Induce Complete Attachment) technique among patients with complicated acute or subacute type B aortic dissection.

Methods: A retrospective single-centre study that evaluates clinical and morphological outcomes among 65 consecutive patients. The area and diameter of the true and false lumen, overall aortic diameter and false lumen perfusion were evaluated.

Results: Concomitant direct visceral artery stenting was successfully conducted in 32 (49%) patients. There was one (1.5%) postoperative stroke; three (4.6%) patients developed spinal cord ischaemia; two (3%) patients suffered retrograde type A dissection; and two (3%) patients had mesenteric ischaemia, despite successful reperfusion, that required a bowel resection. Median postoperative follow-up was 63.1 (interquartile range, 32.1- 91.8) months. The probability of survival was 96.9% [95% confidence interval (CI) 88.3%-99.2%] at 30 days, 93.9% (95% CI 84.4%-97.6%) at 1 year, 78.0 (95% CI 64.2%-87.0%) at 5 years and 72.8% (95% CI at 57.9%-83.2%) at 10 years postoperatively. There was a statistically significant postoperative increase in true-lumen area, diameter and true-lumen index in all five aortic levels measured. Complete false lumen (FL) thrombosis at the coeliac trunk, renal arteries and aortic bifurcation levels was observed in 47%, 15% and 24% of patients at midterm (6-15 months) and in 29%, 21% and 29% on late (later than 21 months) computed tomography angiograms (CTA). Persistent false lumen (FL) perfusion at the coeliac level on midterm CTA was associated with a larger extent of late aortic growth (P = 0.042) and was, in the majority of cases, caused by iliac re-entries either alone (28.57) or in combination with visceral and lumbar (28.57%) or distal aortic (10.71%) re-entries. A larger abdominal aortic diameter at midterm was associated with an increased probability of distal aortic reinterventions (hazard ratio 7.26, 95% CI 2.41-21.9, P < 0.001).

Conclusions: Persistent FL perfusion of the distal aorta at midterm following TEVAR with the PETTICOAT technique among patients with acute and subacute type B dissection is caused mainly by iliac, visceral, lumber and distal aorta re-entries. Patients with persistent FL perfusion have an increased risk of aortic aneurysmal growth at late follow-up.

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复杂b型主动脉夹层患者经远端延伸裸金属支架胸腔内修复后的主动脉重构和晚期预后
目的:本研究的目的是描述在并发急性或亚急性B型主动脉夹层患者中,应用PETTICOAT(临时延伸诱导完全附着)技术进行胸腔血管内主动脉修复术后中晚期主动脉重构的影响因素。方法:回顾性单中心研究,评估65例连续患者的临床和形态学结果。评估真、假腔面积、直径、主动脉总直径及假腔灌注情况。结果:32例(49%)患者成功行直接内脏动脉支架植入术。术后卒中1例(1.5%);3例(4.6%)患者发生脊髓缺血;2例(3%)患者发生逆行A型夹层;2例(3%)患者有肠系膜缺血,尽管再灌注成功,但需要肠切除术。术后中位随访时间为63.1个月(四分位数间距为32.1 ~ 91.8个月)。术后30天生存率为96.9%[95%可信区间(CI) 88.3% ~ 99.2%], 1年生存率为93.9% (95% CI 84.4% ~ 97.6%), 5年生存率为78.0 (95% CI 64.2% ~ 87.0%), 10年生存率为72.8% (95% CI 57.9% ~ 83.2%)。术后真腔面积、直径和真腔指数均有统计学意义的增加。在中期(6-15个月),47%、15%和24%的患者在腹腔干、肾动脉和主动脉分叉水平观察到完全假腔(FL)血栓形成,在晚期(21个月以上)ct血管造影(CTA)中观察到29%、21%和29%的患者出现完全性假腔血栓形成。中期CTA显示腹腔水平持续假腔(FL)灌注与较大程度的晚期主动脉生长相关(P = 0.042),并且在大多数情况下,由髂再入引起,单独(28.57%)或合并内脏和腰椎(28.57%)或远端主动脉(10.71%)再入。中期腹主动脉直径增大与主动脉远端再介入的可能性增加相关(风险比7.26,95% CI 2.41-21.9, P)。结论:急性和亚急性B型夹层患者采用PETTICOAT技术进行TEVAR后中期远端主动脉持续FL灌注主要是由髂、内脏、腰椎和远端主动脉再进入引起的。持续FL灌注的患者在后期随访时动脉瘤生长的风险增加。
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来源期刊
Interactive cardiovascular and thoracic surgery
Interactive cardiovascular and thoracic surgery CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.30
自引率
0.00%
发文量
292
审稿时长
2-4 weeks
期刊介绍: Interactive CardioVascular and Thoracic Surgery (ICVTS) publishes scientific contributions in the field of cardiovascular and thoracic surgery, covering all aspects of surgery of the heart, vessels and the chest. The journal publishes a range of article types including: Best Evidence Topics; Brief Communications; Case Reports; Original Articles; State-of-the-Art; Work in Progress Report.
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