Clinical Analysis Of Distal Descending Aorta’s Remodeling After "Sun’s Procedure" For Acute De BakeyⅠAortic Dissection

Objectives:The objectives were to study DeBakeyⅠ aortic dissection after “sun’s procedure”,based on CTA,to explore the roles between distal lumen and residual entry tears,entry tears location,aortic calcification,main branch involvement,valve and connective tissue disease.Methods:Collecting patients with DeBakeyⅠ dissection who are treated with “sun’s procedure”(ascending aorta replacement,aortic arch replacement and descending aorta stent implantation)in our hospital,At least 3 times of aortic CTA examination,Select three sections include left subclavian artery at the 2cm level,celiac trunk,right renal artery level in three sections,measured with the true and false lumen diameter and average diameter changes,true and false lumen area changes.Observe degree of thrombus in Stenting segment,the end of the stent to the celiac trunk segment,the celiac trunk to right renal artery segment.Observing stent leakage,numbers of postoperative entry tears,locations of entry tears,the aorta calcification,valve treatment and the main branches.Results:A total of 118 patients,finally 35 patients with complete follow-up,32 male cases,3 female cases,follow-up time of 4-26 months,at least having 3 Thoracic and abdominal aorta CTA.in aortic isthmus level,celiac level and right renal artery level,measuring the maximum diameter and the average diameter of the true lumen,false lumen’s maximum diameter and average diameter,the area of the true lumen,false lumen area.each level of the area of the false lumen decreases,The aortic isthmus area of the aortic flase lumen decreased with the time of measurement;The area of the flase lumen at the level of the celiac trunk increased at 1 month after operation,then decreased afterwards.The area of the false lumen at the level of right renal artery was enlarged in four-time periods.Aortic isthmus complete thrombosis,false lumen disappear in the proportion at the 1 month,3-6 months,more than 6 months after surgery were 14.29%,71.43%,83.33%.The incidence of adverse events in the false-lumen expansion group and the false-lumen reduction group have no statistically significant(p <0.05).Descending aortic remodeling after ascending aorta replacement,aortic arch replacement,distal aortic stent implantation,the number of entry tears(one case of stent leakage,attributed to the break treatment),the location of entry tears,mian branch vascular involvement,valve replacement or valvuloplasty has a significant relationship(p <0.05).Descending aortic lumen remodeling after operation had no significant relationship with the gender,age,smoking history,drinking history,history of hypertension,aortic calcification and other factors(p <0.05).Coronary heart disease and Marfan syndrome has no statistical significance because of less cases.the true lumen diameter and area increases gradually,the aortic isthmus remodeling rate is the highest,the distal remodeling rate is low,the degree of thrombosis appear much lower to the distal the ascending aorta.DeBakeyⅠ aortic dissection after “sun’s procedure”,the stent leakage,rupture number,rupture location,number of branch vessels involvement and vavle replacement or valvuloplasty can influence of descending aorta’s morphological changes and geometric changes.The more number of postoperative residual tear entry,the higher location of the tear entry,the more number of branches involvement,and the influence of valve replacement or valvuloplasty which will enlarge the area and diameter of the false lumen.Conclusions:DeBakeyⅠ type dissection for“sun’s procedure”,its clinical effect is affirmative.in the stent segment aortic true lumen is effectively expanded,as the false lumen narrow or even disappear,a higher level of thrombosis degree;the true lumen at the level of the celiac slowly expanded,the false lumen slowly decreased,the degree of thrombosis was worse than that of the stent;the true and false lumen at the level of right renal artery showed a slow increasing trend,and the thrombus level was worse than that of the stent and celiac cavity;The degree of arterial thrombosis,the number and location of the entry tears,the number of branch vessels involved,the valve replacement or valvuloplasty and other factors can affect the remodeling of the descending aorta.the number of entry tears,higher location entry tears,the main branch of vascular involvement is the risk factors of the true lumen enlargement limited and false lumen increasing.can find the adverse prognostic factors,conducting long-term management after surgery,and can guide the early intervention.