Comparison Of Curative Effect And Aortic Remodeling After Endovascular Repair Of Type B Aortic Dissection For Different Times

Objective:To compare the different effects and morphology of postoperative aortic remodeling of endovascular graft exclusion in the treatment of subacute and chronic thoracic aortic dissection.Methods:This study collected 84 patients(25 subacute and 59 chronic)with Stanford type B aortic dissection who were treated in our hospital from January 2013 to January 2015.The outcomes of endovascular graft exclusion in patients with subacute and chronic thoracic aortic dissection were compared by analyzing the clinical indicators,imaging examinations,and postoperative follow-up.The differences in postoperative remodeling results of the different segments of the aorta and the different segments of the aorta were also evaluated,and the factors affecting aortic remodeling were analyzed.Useing the Logrank method to analyze the outcomes of two group,and COX regression were used to analyze aortic remodeling related multiple risk factors,when P<0.05 considered a statistically significant difference.Results:The preoperative clinical and radiological datas showed that the subacute group’s true lumen collapse(28.00%vs 54.24%,P=0.027),tumor-like expansion(12.00%vs 44.15%,P=0.001),dissection or aura rupture(4.00%vs 0.00%,P=0.007).Smoothing of the aorta false lumen(64.00%vs 86.44%,P=0.019)was lower than the chronic group.Twenty-five patients in the subacute group who underwent endovascular graft exclusion were all successful.The perioperative and postoperative follow-up results showed that the probability of reoperation and the incidence of complications in subacute group were significantly lower than those in chronic group(P<0.05).There was no difference of statistics in both groups of the overall survival rate(P=0.087).In both groups,the diameter of the true lumen was increased and the the false lumen was decreased after the operation.The diameter of the stent segment changes was the most significant,the distal segment of the stent decreased,and the level below the abdominal lumen does not change.The diameter of the false lumens in the subacute group was smaller than that in the chronic group,and the change of the diameter of the false lumen after the operation was significant(P<0.05).The proportion of patients with complete absorption of thoracic aortic false lumen thrombosis(87.50%vs 49.09%,P=0.001)in the acute group was higher than that in the chronic phase group.The proportion of patients with false lumen partial thrombosis was higher in the acute group(50.91%vs 12.50%,P=0.001).The independent factors influencing the remodeling of the false lumen included age,true cavity collapse,tumor dilatation,residual tear,the degree of thrombus in the false lumen of thoracic aorta,and endoleak(P<0.05).The age,aneurysmal dilatation and endoleak were the independent risk factors for false cavity remodeling(OR>1).The degree of thrombus in the false lumen of thoracic aorta is an independent protective factor for false cavity remodeling(OR<1).Conclusion:The intima of the aorta in the subacute thoracic aortic dissection is stable.The results of the follow-up showed that the outcomes of the treatment were better than chronic thoracic aortic dissection.The subacute thoracic aortic dissection acquired a longer life period,and the morphological remodeling of the artery was better than that of the chronic.The diameter of the stent segment changes was the most significant,the distal segment of the stent decreased,and the level below the abdominal lumen does not change.The age,aneurysmal dilatation,endoleak and the degree of thrombus in the false lumen of thoracic aorta were the independent factors for reconstruction of the false lumen after the operation.