| Part one:Mid-term clinical outcome comparison between acute and non-acute type B aortic dissection after endovascular therapyObjective:With the development of endovascular technique, thoracic endovascular aortic repair (TEVAR) has increasingly been used in the management of type B aortic dissection (TBAD). However, the appropriate timing of TEVAR for TBAD continues to be a subject of debate in acute or non-acute phase. The aim of this study was to assess retrospectively our experience in the endovascular repair of patients with TBAD.Methods:From January 1,2010, to December 31,2014, a total of 261 consecutive patients with TBAD undergoing TEVAR in Tongji hospital (Wuhan, China) were selected and divided into acute (<14 days) group (n=190) and non-acute (≥14 days) group (n=71). The risk factors, clinical features, procedural results, computed tomography images, and follow-up outcomes of all the patients were documented and compared between the two groups.Results:Clinical data was similar between groups. Acute patients were more likely to present with chest, back, and abrupt onset of pain (all p<0.05). Acute patients were also likely to present with higher systolic and diastolic blood pressure (all p<0.05) on admission. The technical success rate of TEVAR was 100%(261/261). Only 1 patient in non-acute group died in-hospital after procedure because of dissection rupture. Complications, including retrograde type A dissection, acute renal failure requiring dialysis, paraplegia/paraparesis, and overall stroke were similar between the two groups. The median follow-up time was 36 months (range,23-51 months). Kaplan-Meier survival estimates showed no significant difference in overall survival rate (94% vs.83%, p=0.056), freedom from aorta-related death (95% vs.97%, P=0.533), and freedom from re-intervention rate (89% vs.74%, p=0.169) at 5 years between the two groups.Conclusion:Mid-term outcomes showed TEVAR to be a safe and effective approach to the management of TBAD in both acute and non-acute stage. Further prospective clinical trials are warranted to assess its long-term efficacy.Part two:Aortic morphologic analysis after TEVAR for acute type B aortic dissectionObjective:The aim of this study was to evaluate aortic morphologic findings after thoracic endovascular aortic repair (TEVAR) for acute Stanford type B aortic dissection (TBAD) by measuring the diameter and area of the true and false lumen on pre/post-procedure.Methods:The study identified patients who had an index hospital admission between January 1,2010, and December 31,2014, with a primary diagnosis of TBAD, managed with TEVAR. Clinical follow-up and computed tomography angiography (CTA) were scheduled after the TEVAR procedure. Image-Pro Plus (IPP, Version 6.0, Media Cybernetics, Inc, USA) was used to calculate aortic diameters and areas of the true and false lumen on the level of descending thoracic aortic isthmus (level A), middle descending aorta (level B), distal descending aorta (level C) and celiac trunk (level D) of the aorta CTA.Results:A total of 172 patients with acute TBAD treated by TEVAR were studied retrospectively. Of these, male accounts for 153(89%), and the mean age was 51.2±10.6 years. TEVAR was completed successfully in all patients with no death during intra-operative and 30 days after procedure. The median follow-up period was 36 (23-51) months.8 patients lost to follow-up, and the follow-up rate was 95.3%. Apart from level D (11.5±4.2 vs.13.9±4.0, P=0.210), other levels all showed significant increase in the true lumen diameter when comparing pre-and post-TEVAR values (all P<0.001). These results were related to decrease in the false lumen diameter. In the meantime, the difference of true lumen area increase was significant (all P<0.05) between the pre- and post-procedural measurements. Apart from level D (180.0±103.7 vs.128.9±83.3, P=0.240), other levels all showed significant decrease in the false lumen area when comparing pre- and post-TEVAR values (all P< 0.05). Level A’s false lumen thrombosis (FLT) account for the highest percentage, with it complete and partial FLT percentage being 87.5 and 7.9, respectively. The percentage FLT of Level B is slightly lower that of level A, with it complete and partial FLT percentage being 86.2 and 9.2, respectively. The complete and partial FLT of level C account for 71.1% and 22.3%. As for the level D, the FLT is the lowest, with it complete and partial FLT percentage being 12.5 and 28.2.Conclusion:The aortic morphology of the thoracic aorta after TEVAR for acute type B AD significantly altered, accompany by FLT with progressive reduction of its diameter/area and concomitant progressive enlargement of the true lumen. However, the sample size of this study is relatively small. This conclusion remains to be confirmed by other clinical studies with large sample size. Furthermore, further therapeutic schedule will be required to settle the challenge of unfavorable aortic remodeling of the abdominal aorta. |
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